Provider Demographics
NPI:1790847069
Name:GERIATRIC FOOT SPECIALISTS, INC
Entity Type:Organization
Organization Name:GERIATRIC FOOT SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-546-6459
Mailing Address - Street 1:317 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1835
Mailing Address - Country:US
Mailing Address - Phone:856-546-6459
Mailing Address - Fax:856-546-7636
Practice Address - Street 1:317 10TH AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1835
Practice Address - Country:US
Practice Address - Phone:856-546-6459
Practice Address - Fax:856-546-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00092800313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3252906Medicaid
NJT44620Medicare UPIN
NJ3252906Medicaid
NJ6050230001Medicare NSC