Provider Demographics
NPI:1063550358
Name:MEDICAL FOOT CARE CENTER, P.C.
Entity type:Organization
Organization Name:MEDICAL FOOT CARE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:HAYNES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-485-6799
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07051-0337
Mailing Address - Country:US
Mailing Address - Phone:908-527-2909
Mailing Address - Fax:908-634-1000
Practice Address - Street 1:500 ORANGE ST
Practice Address - Street 2:SUITE# 301
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2944
Practice Address - Country:US
Practice Address - Phone:973-485-6799
Practice Address - Fax:973-485-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3901890001Medicare NSC