Provider Demographics
NPI:1770877573
Name:DIABETIC FOOT CENTER, LLC
Entity type:Organization
Organization Name:DIABETIC FOOT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-582-3968
Mailing Address - Street 1:215 EDGEWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091
Mailing Address - Country:US
Mailing Address - Phone:856-809-9910
Mailing Address - Fax:856-809-9945
Practice Address - Street 1:245 FRIES MILL RD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2059
Practice Address - Country:US
Practice Address - Phone:856-582-3968
Practice Address - Fax:856-582-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400393527332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies