Provider Demographics
NPI:1578839866
Name:GARDEN STATE FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:GARDEN STATE FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHREM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-547-9124
Mailing Address - Street 1:7 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1332
Mailing Address - Country:US
Mailing Address - Phone:732-547-9124
Mailing Address - Fax:
Practice Address - Street 1:226 MIDDLE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1945
Practice Address - Country:US
Practice Address - Phone:732-547-9124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00302900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ189437Medicare PIN