Provider Demographics
NPI:1992993018
Name:EDGEWATER FOOT AND ANKLE ASSOCIATES, PC
Entity type:Organization
Organization Name:EDGEWATER FOOT AND ANKLE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-224-8300
Mailing Address - Street 1:968 RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2237
Mailing Address - Country:US
Mailing Address - Phone:201-224-8300
Mailing Address - Fax:810-958-2764
Practice Address - Street 1:968 RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2237
Practice Address - Country:US
Practice Address - Phone:201-224-8300
Practice Address - Fax:810-958-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty