Provider Demographics
NPI:1023310117
Name:METRO MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:METRO MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NDIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:UFONDU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-435-5500
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-1093
Mailing Address - Country:US
Mailing Address - Phone:201-435-5500
Mailing Address - Fax:
Practice Address - Street 1:434 WESTSIDE AVE
Practice Address - Street 2:STE. A
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-435-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00296800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1386805919OtherNPI INDIVIDUAL
NJ191239OtherMEDICARE PTAN
NJ134914OtherMEDICARE PTAN INDIVIDUAL
NJ1386805919OtherNPI INDIVIDUAL