Provider Demographics
NPI:1710342605
Name:PRFAA LLC
Entity Type:Organization
Organization Name:PRFAA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-448-1292
Mailing Address - Street 1:113 MAPLE STREAM RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2459
Mailing Address - Country:US
Mailing Address - Phone:609-448-1292
Mailing Address - Fax:609-448-3507
Practice Address - Street 1:113 MAPLE STREAM RD
Practice Address - Street 2:SUITE 3
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2459
Practice Address - Country:US
Practice Address - Phone:609-448-1292
Practice Address - Fax:609-448-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00135000213ES0103X
NJ25MD00275300213ES0103X
NJ25MD00322700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1477560910OtherNPI
NJ1194730671OtherNPI
NJ1609127257OtherNPI