Provider Demographics
NPI:1588618722
Name:FUSFIELD PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:FUSFIELD PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FUSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-267-2693
Mailing Address - Street 1:516 HIGH ST
Mailing Address - Street 2:UNIT 11
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1026
Mailing Address - Country:US
Mailing Address - Phone:609-267-2693
Mailing Address - Fax:609-267-5415
Practice Address - Street 1:516 HIGH ST
Practice Address - Street 2:UNIT 11
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1026
Practice Address - Country:US
Practice Address - Phone:609-267-2693
Practice Address - Fax:609-267-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00108400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081213Medicaid
NJ094277Medicare ID - Type Unspecified