Provider Demographics
NPI:1942493432
Name:NORTH ATLANTIC PODIATRY LLC
Entity Type:Organization
Organization Name:NORTH ATLANTIC PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-579-3173
Mailing Address - Street 1:376 LAFAYETTE RD RT 15 SO
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:973-579-3173
Mailing Address - Fax:973-579-2961
Practice Address - Street 1:376 LAFAYETTE RD RT 15 SO
Practice Address - Street 2:SUITE 101
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871
Practice Address - Country:US
Practice Address - Phone:973-579-3173
Practice Address - Fax:973-579-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD002672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9081402Medicaid
NJU92823Medicare UPIN
NJ9081402Medicaid