Provider Demographics
NPI:1568966505
Name:PROMPT PODIATRY MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:PROMPT PODIATRY MEDICAL MANAGEMENT
Other - Org Name:PREMIERE FOOT AND ANKLE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-659-5222
Mailing Address - Street 1:108 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4659
Mailing Address - Country:US
Mailing Address - Phone:201-659-5222
Mailing Address - Fax:201-659-0847
Practice Address - Street 1:108 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4659
Practice Address - Country:US
Practice Address - Phone:201-659-5222
Practice Address - Fax:201-659-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1780055137OtherNPI