Provider Demographics
NPI:1184939845
Name:MANHEIM FAMILY FOOT CARE LLC
Entity type:Organization
Organization Name:MANHEIM FAMILY FOOT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-917-3785
Mailing Address - Street 1:95 CLARKEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3444
Mailing Address - Country:US
Mailing Address - Phone:973-917-3785
Mailing Address - Fax:973-917-3786
Practice Address - Street 1:3219 ROUTE 46
Practice Address - Street 2:SUITE 210
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1278
Practice Address - Country:US
Practice Address - Phone:973-917-3785
Practice Address - Fax:973-917-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ172421Medicare PIN
NJ6389600003Medicare NSC