Provider Demographics
NPI:1932119179
Name:DOVER FOOT CARE
Entity Type:Organization
Organization Name:DOVER FOOT CARE
Other - Org Name:RAYMOND IVANOVS, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOVS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-366-8000
Mailing Address - Street 1:387 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2520
Mailing Address - Country:US
Mailing Address - Phone:973-366-8000
Mailing Address - Fax:973-442-1300
Practice Address - Street 1:387 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2520
Practice Address - Country:US
Practice Address - Phone:973-366-8000
Practice Address - Fax:973-442-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046710Medicaid
NJ073563Medicare ID - Type Unspecified
NJ5643060001Medicare NSC