Provider Demographics
NPI:1952857757
Name:CEDAR GROVE FOOT AND ANKLE SPECIALISTS P.C.
Entity Type:Organization
Organization Name:CEDAR GROVE FOOT AND ANKLE SPECIALISTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:F
Authorized Official - Last Name:WACHTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-857-1184
Mailing Address - Street 1:882 POMPTON AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1256
Mailing Address - Country:US
Mailing Address - Phone:973-857-1184
Mailing Address - Fax:973-857-3114
Practice Address - Street 1:882 POMPTON AVE STE B1
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1256
Practice Address - Country:US
Practice Address - Phone:973-857-1184
Practice Address - Fax:973-857-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00314900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7571900001Medicare NSC