Provider Demographics
NPI:1861551319
Name:ATLANTIC FOOT AND ANKLE CARE PC
Entity type:Organization
Organization Name:ATLANTIC FOOT AND ANKLE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOWALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-753-0913
Mailing Address - Street 1:76 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9411
Mailing Address - Country:US
Mailing Address - Phone:609-404-1300
Mailing Address - Fax:609-404-1929
Practice Address - Street 1:76 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9411
Practice Address - Country:US
Practice Address - Phone:609-404-1300
Practice Address - Fax:609-404-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7474504Medicaid
0688810002Medicare NSC
NJ7474504Medicaid
CM2213Medicare PIN