Provider Demographics
NPI:1740340652
Name:ASSOCIATES IN PODIATRIC MEDICINE & SURGERY, PC
Entity type:Organization
Organization Name:ASSOCIATES IN PODIATRIC MEDICINE & SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TWARDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-344-3900
Mailing Address - Street 1:4503 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-5733
Mailing Address - Country:US
Mailing Address - Phone:609-344-3900
Mailing Address - Fax:
Practice Address - Street 1:4503 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-5733
Practice Address - Country:US
Practice Address - Phone:609-344-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3202101Medicaid
NJ3202101Medicaid