Provider Demographics
NPI:1073726972
Name:EDISON FOOT AND ANKLE CARE PC
Entity type:Organization
Organization Name:EDISON FOOT AND ANKLE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING REP
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-494-5601
Mailing Address - Street 1:1037 AMBOY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2917
Mailing Address - Country:US
Mailing Address - Phone:732-494-5601
Mailing Address - Fax:732-321-6530
Practice Address - Street 1:1037 AMBOY AVE STE 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2917
Practice Address - Country:US
Practice Address - Phone:732-494-5601
Practice Address - Fax:732-321-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003040001Medicare NSC
NJ110594Medicare UPIN