Provider Demographics
NPI:1952494510
Name:SOUTH JERSEY FOOT & ANKLE CENTERS
Entity Type:Organization
Organization Name:SOUTH JERSEY FOOT & ANKLE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KRAATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-854-3093
Mailing Address - Street 1:570 HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1449
Mailing Address - Country:US
Mailing Address - Phone:856-854-3093
Mailing Address - Fax:856-854-7969
Practice Address - Street 1:570 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1449
Practice Address - Country:US
Practice Address - Phone:856-854-3093
Practice Address - Fax:856-854-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00145200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000445700OtherAMERICHOICE
NJCG7953OtherRAILROAD MEDICARE
NJ0072427000OtherAMERIHEALTH
NJ3K4669OtherHEALTH NET
NJ7771100Medicaid
NJ1012298OtherHORIZON MERCY
NJ25032OtherAETNA
NJ25032OtherAETNA
NJ4656430001Medicare NSC