Provider Demographics
NPI:1316475973
Name:BRICK FOOT & ANKLE CENTER, PC
Entity type:Organization
Organization Name:BRICK FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-683-1133
Mailing Address - Street 1:5 ANNA ROSE CT
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2270
Mailing Address - Country:US
Mailing Address - Phone:201-683-1133
Mailing Address - Fax:
Practice Address - Street 1:292 HERBERTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1734
Practice Address - Country:US
Practice Address - Phone:732-840-8989
Practice Address - Fax:732-840-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598058554Other1598058554