Provider Demographics
NPI:1891899092
Name:GIBBONS FOOT & ANKLE GROUP LLC
Entity Type:Organization
Organization Name:GIBBONS FOOT & ANKLE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-254-2609
Mailing Address - Street 1:8 AUER COURT
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-254-2609
Mailing Address - Fax:732-238-6269
Practice Address - Street 1:8 AUER COURT
Practice Address - Street 2:SUITE C & D
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-254-2609
Practice Address - Fax:732-238-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00194800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4602501Medicaid
NJ099508OtherMEDICARE GRP NUMBER
U17438Medicare UPIN
NJ671761468Medicare ID - Type Unspecified
NJ099508OtherMEDICARE GRP NUMBER