Provider Demographics
NPI:1275676421
Name:ADVANCED PODIATRIC SERVICES
Entity Type:Organization
Organization Name:ADVANCED PODIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEGARA
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-848-3338
Mailing Address - Street 1:341 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2715
Mailing Address - Country:US
Mailing Address - Phone:856-848-3338
Mailing Address - Fax:856-848-5122
Practice Address - Street 1:341 S EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2715
Practice Address - Country:US
Practice Address - Phone:856-848-3338
Practice Address - Fax:856-848-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ25MD00273100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5101610002OtherMEDICARE DME
NJ0103462Medicaid
NJ3650342OtherAETNA
NJ3650342OtherAETNA
NJ095909Medicare ID - Type Unspecified