Provider Demographics
NPI:1346595089
Name:ESSENTIAL FOOT CARE PC
Entity type:Organization
Organization Name:ESSENTIAL FOOT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUKOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-783-0039
Mailing Address - Street 1:20 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4546
Mailing Address - Country:US
Mailing Address - Phone:856-783-0039
Mailing Address - Fax:856-783-2312
Practice Address - Street 1:20 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4546
Practice Address - Country:US
Practice Address - Phone:651-747-7748
Practice Address - Fax:856-783-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00313500261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0315486Medicaid
PA1027606800001Medicaid