Provider Demographics
NPI:1972657310
Name:BAYSIDE FOOT & ANKLE
Entity Type:Organization
Organization Name:BAYSIDE FOOT & ANKLE
Other - Org Name:DR SANDRA DALTON
Other - Org Type:Other Name
Authorized Official - Title/Position:OM
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-926-7006
Mailing Address - Street 1:501 BAY AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-926-7006
Mailing Address - Fax:609-926-7016
Practice Address - Street 1:501 BAY AVE
Practice Address - Street 2:STE 103
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-926-7006
Practice Address - Fax:609-926-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00248000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ813300Medicaid
NJ010852Medicare ID - Type Unspecified
U70819Medicare UPIN