Provider Demographics
NPI:1700891496
Name:JEFFREY S KATZ DPM PA
Entity Type:Organization
Organization Name:JEFFREY S KATZ DPM PA
Other - Org Name:ADVANCED FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-691-1287
Mailing Address - Street 1:92 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4851
Mailing Address - Country:US
Mailing Address - Phone:856-691-1287
Mailing Address - Fax:856-691-3037
Practice Address - Street 1:92 S STATE ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4851
Practice Address - Country:US
Practice Address - Phone:856-691-1287
Practice Address - Fax:856-691-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01066213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2999005Medicaid
NJ2999005Medicaid
NJ0781600001Medicare NSC