Provider Demographics
NPI:1942834973
Name:FOOT & ANKLE CENTER OF SJ
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF SJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHLGEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-404-0400
Mailing Address - Street 1:408 CHRIS GAUPP DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-404-0700
Mailing Address - Fax:609-404-0712
Practice Address - Street 1:408 CHRIS GAUPP DR STE 300
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-404-0700
Practice Address - Fax:609-404-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty