Provider Demographics
NPI:1992129423
Name:FOOTPRINTS HAMILTON OPERATIONS, LLC
Entity type:Organization
Organization Name:FOOTPRINTS HAMILTON OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-961-9991
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0090
Mailing Address - Country:US
Mailing Address - Phone:609-249-4645
Mailing Address - Fax:
Practice Address - Street 1:3535 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1200
Practice Address - Country:US
Practice Address - Phone:609-249-4645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder