Provider Demographics
NPI:1609883370
Name:FOOT SPECIALISTS OF MOORESTOWN, PC
Entity Type:Organization
Organization Name:FOOT SPECIALISTS OF MOORESTOWN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SANTOMAURO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-866-8998
Mailing Address - Street 1:400 N CHURCH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1700
Mailing Address - Country:US
Mailing Address - Phone:856-866-8998
Mailing Address - Fax:856-866-9746
Practice Address - Street 1:400 N CHURCH ST STE 125
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1700
Practice Address - Country:US
Practice Address - Phone:856-866-8998
Practice Address - Fax:856-866-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00287500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4388810001Medicaid
NJV05373Medicare UPIN
NJ028144Medicare ID - Type UnspecifiedGROUP ACCOUNT
NJ4388810001Medicaid