Provider Demographics
NPI:1457381634
Name:PORT RICHMOND FAMILY FOOT CARE,PC
Entity Type:Organization
Organization Name:PORT RICHMOND FAMILY FOOT CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-261-2223
Mailing Address - Street 1:1561 ROUTE 38 STE 4
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2939
Mailing Address - Country:US
Mailing Address - Phone:609-261-2223
Mailing Address - Fax:609-702-1111
Practice Address - Street 1:1561 ROUTE 38 STE 4
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2939
Practice Address - Country:US
Practice Address - Phone:609-261-2223
Practice Address - Fax:609-702-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X
PA4744650001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA544104Medicare ID - Type Unspecified
NJ735706Medicare ID - Type Unspecified
PA4744650001Medicare NSC