Provider Demographics
NPI:1629224894
Name:CENTRAL JERSEY FOOT AND ANKLE CARE, P.C.
Entity Type:Organization
Organization Name:CENTRAL JERSEY FOOT AND ANKLE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-866-4411
Mailing Address - Street 1:701 TENNENT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3193
Mailing Address - Country:US
Mailing Address - Phone:732-866-4411
Mailing Address - Fax:732-866-0044
Practice Address - Street 1:701 TENNENT RD STE 101
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3193
Practice Address - Country:US
Practice Address - Phone:732-866-4411
Practice Address - Fax:732-866-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00231100332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4559440001Medicare NSC