Provider Demographics
NPI:1104257336
Name:AMERICAN FOOT & ANKLE CENTER PA
Entity type:Organization
Organization Name:AMERICAN FOOT & ANKLE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-222-9110
Mailing Address - Street 1:60 STATE RT 36
Mailing Address - Street 2:STE A2
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1464
Mailing Address - Country:US
Mailing Address - Phone:732-222-9110
Mailing Address - Fax:
Practice Address - Street 1:60 STATE RT 36
Practice Address - Street 2:STE A2
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1464
Practice Address - Country:US
Practice Address - Phone:732-222-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00210900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty