Provider Demographics
NPI:1851577639
Name:FEOLA FOOT AND ANKLE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FEOLA FOOT AND ANKLE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-583-4800
Mailing Address - Street 1:100 BELCHASE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9728
Mailing Address - Country:US
Mailing Address - Phone:732-583-4800
Mailing Address - Fax:732-583-0448
Practice Address - Street 1:100 BELCHASE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-9728
Practice Address - Country:US
Practice Address - Phone:732-583-4800
Practice Address - Fax:732-583-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD002635213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1164461927OtherNPI TYPE 1
NJ8476306Medicaid
NJ8476306Medicaid
NJ4134890001Medicare NSC
NJ046920Medicare PIN