Provider Demographics
NPI:1952409245
Name:THE CENTRE FOR FOOT & ANKLE CARE, P.A.
Entity Type:Organization
Organization Name:THE CENTRE FOR FOOT & ANKLE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANCILLERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-653-2020
Mailing Address - Street 1:403 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2188
Mailing Address - Country:US
Mailing Address - Phone:609-653-2020
Mailing Address - Fax:609-653-3110
Practice Address - Street 1:403 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2188
Practice Address - Country:US
Practice Address - Phone:609-653-2020
Practice Address - Fax:609-653-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001971213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU01911Medicare UPIN
NJ624820Medicare ID - Type Unspecified
NJ0990060001Medicare NSC