Provider Demographics
NPI:1881864585
Name:COMMUNITY FOOT & ANKLE CTR
Entity Type:Organization
Organization Name:COMMUNITY FOOT & ANKLE CTR
Other - Org Name:COMMUNITY FOOT & ANKLE CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-473-9006
Mailing Address - Street 1:517 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8020
Mailing Address - Country:US
Mailing Address - Phone:732-473-9006
Mailing Address - Fax:732-286-1901
Practice Address - Street 1:517 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8020
Practice Address - Country:US
Practice Address - Phone:732-473-9006
Practice Address - Fax:732-286-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6254608Medicaid
NJ6254608Medicaid
NJ624640Medicare PIN
NJ0177040001Medicare NSC