Provider Demographics
NPI:1962430645
Name:AFFILIATED FOOT SURGEONS, PA
Entity type:Organization
Organization Name:AFFILIATED FOOT SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-616-7117
Mailing Address - Street 1:70 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2850
Mailing Address - Country:US
Mailing Address - Phone:973-616-7117
Mailing Address - Fax:973-616-7338
Practice Address - Street 1:70 W 32ND ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2850
Practice Address - Country:US
Practice Address - Phone:973-616-7117
Practice Address - Fax:973-616-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9073302Medicaid
NJ=========OtherUHC RR GROUP NUMBER
NJ057112Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NJ5379030001Medicare NSC