Provider Demographics
NPI:1649426362
Name:HARO PODIATRY CENTER PC
Entity type:Organization
Organization Name:HARO PODIATRY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-777-5771
Mailing Address - Street 1:1005 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3520
Mailing Address - Country:US
Mailing Address - Phone:973-777-5771
Mailing Address - Fax:973-777-8229
Practice Address - Street 1:1005 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3520
Practice Address - Country:US
Practice Address - Phone:973-777-5771
Practice Address - Fax:973-777-8229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00260400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2116157000OtherAMERIHEALTH
2K8060OtherHEALTH NET
NJ1156209OtherNJ HEALTH
NJ010004607-02OtherAMERICHOICE
NJ8641102Medicaid
P2530146OtherOXFORD
P00110397OtherRAIL ROAD MEDICARE
9647690OtherGHI
0450694003OtherCIGNA
9647690OtherGHI
0450694003OtherCIGNA
NJ=========OtherBLUE CROSS BLUE SHEILD
P2530146OtherOXFORD
2K8060OtherHEALTH NET
=========OtherPHCS
=========OtherQUALCARE
9647690OtherGHI