Provider Demographics
NPI:1669542239
Name:GREATER SALEM FAMILY FOOTCARE ASSOCIATES PC
Entity type:Organization
Organization Name:GREATER SALEM FAMILY FOOTCARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORGOL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-898-5864
Mailing Address - Street 1:198 MAIN ST
Mailing Address - Street 2:GREATER SALEM FAMILY FOOTCARE ASSOCIATES PC
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079
Mailing Address - Country:US
Mailing Address - Phone:603-898-5864
Mailing Address - Fax:603-898-1207
Practice Address - Street 1:198 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3113
Practice Address - Country:US
Practice Address - Phone:603-898-5864
Practice Address - Fax:603-898-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRRE8071Medicare PIN
5646430001Medicare NSC