Provider Demographics
NPI:1881820777
Name:ADVANCED FEET AND ANKLE CARE
Entity Type:Organization
Organization Name:ADVANCED FEET AND ANKLE CARE
Other - Org Name:ADVANCED FOOT AND ANKLE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-679-4330
Mailing Address - Street 1:53 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1559
Mailing Address - Country:US
Mailing Address - Phone:732-679-4330
Mailing Address - Fax:732-679-4777
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-1559
Practice Address - Country:US
Practice Address - Phone:732-679-4330
Practice Address - Fax:732-679-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDO7594Medicare PIN
NJ148440Medicare PIN
NJ6205770002Medicare NSC