Provider Demographics
NPI:1942538178
Name:MANHEIM FAMILY FOOT CARE LLC
Entity Type:Organization
Organization Name:MANHEIM FAMILY FOOT CARE LLC
Other - Org Name:STEP BY STEP FAMILY FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-545-0252
Mailing Address - Street 1:95 CLARKEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3444
Mailing Address - Country:US
Mailing Address - Phone:973-545-0252
Mailing Address - Fax:973-545-0253
Practice Address - Street 1:95 CLARKEN DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3444
Practice Address - Country:US
Practice Address - Phone:973-545-0252
Practice Address - Fax:973-545-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00276100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ172421Medicare PIN
NJ6389600002Medicare NSC