Provider Demographics
NPI:1598128654
Name:OCEAN COUNTY FOOT & ANKLE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:OCEAN COUNTY FOOT & ANKLE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PETRANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-505-4500
Mailing Address - Street 1:54 BEY LEA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2978
Mailing Address - Country:US
Mailing Address - Phone:732-505-4500
Mailing Address - Fax:732-505-9787
Practice Address - Street 1:1178 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4920
Practice Address - Country:US
Practice Address - Phone:732-240-5677
Practice Address - Fax:732-240-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1119700002Medicare PIN