Provider Demographics
NPI:1669519047
Name:WAYNE FOOT AND ANKLE CENTER,PA
Entity type:Organization
Organization Name:WAYNE FOOT AND ANKLE CENTER,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CALLIGARO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-595-8900
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2156
Mailing Address - Country:US
Mailing Address - Phone:973-595-8900
Mailing Address - Fax:973-595-0330
Practice Address - Street 1:246 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 204
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2160
Practice Address - Country:US
Practice Address - Phone:973-595-8900
Practice Address - Fax:973-595-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00108100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123866Medicare PIN
NJT83036Medicare UPIN
NJ0367140001Medicare NSC