Provider Demographics
NPI:1588691810
Name:ASSOCIATED PODIATRIC PHYSICIANS,PA
Entity type:Organization
Organization Name:ASSOCIATED PODIATRIC PHYSICIANS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-586-7111
Mailing Address - Street 1:1300 S OLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-2907
Mailing Address - Country:US
Mailing Address - Phone:609-586-7111
Mailing Address - Fax:609-586-7311
Practice Address - Street 1:1300 S OLDEN AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-2907
Practice Address - Country:US
Practice Address - Phone:609-586-7111
Practice Address - Fax:609-586-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02061213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6537901Medicaid
5460090001OtherDMERC
NJ6537707Medicaid
NJ6537901Medicaid
NJU18537Medicare UPIN
090713Medicare ID - Type UnspecifiedGROUP