Provider Demographics
NPI:1780299339
Name:ON THE GO PODIATRY
Entity type:Organization
Organization Name:ON THE GO PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHIODO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-359-4385
Mailing Address - Street 1:215 WOODSIDE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5051
Mailing Address - Country:US
Mailing Address - Phone:201-359-4385
Mailing Address - Fax:
Practice Address - Street 1:215 WOODSIDE AVE FL 2
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5051
Practice Address - Country:US
Practice Address - Phone:201-359-4385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric