Provider Demographics
NPI:1912053315
Name:FOOTWORKS LLC
Entity type:Organization
Organization Name:FOOTWORKS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KERR
Authorized Official - Suffix:II
Authorized Official - Credentials:CPED
Authorized Official - Phone:609-953-6971
Mailing Address - Street 1:175 ROUTE 70
Mailing Address - Street 2:UNIT 15
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2300
Mailing Address - Country:US
Mailing Address - Phone:609-953-6971
Mailing Address - Fax:609-953-6972
Practice Address - Street 1:175 ROUTE 70
Practice Address - Street 2:UNIT 15
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2300
Practice Address - Country:US
Practice Address - Phone:609-953-6971
Practice Address - Fax:609-953-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006064000OtherAMERIHEALTH
NJ0006064000OtherINDEPENDENCE BLUE CROSS
NJ0006064000OtherAMERIHEALTH
NJ0006064000OtherINDEPENDENCE BLUE CROSS