Provider Demographics
NPI:1992101745
Name:FOOT AND ANKLE SPECIALISTS OF SOUTH JERSEY
Entity type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PODORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-435-4000
Mailing Address - Street 1:117 WHITE HORSE RD E
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2503
Mailing Address - Country:US
Mailing Address - Phone:856-435-4000
Mailing Address - Fax:856-435-6866
Practice Address - Street 1:117 WHITE HORSE RD E
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2503
Practice Address - Country:US
Practice Address - Phone:856-435-4000
Practice Address - Fax:856-435-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00255900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68408Medicare UPIN
036805MU9Medicare PIN