Healthcare Provider Details

I. General information

NPI: 1881715647
Provider Name (Legal Business Name): ACTIVE FOOT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 UNION ST
DOVER NJ
07801-4030
US

IV. Provider business mailing address

77 UNION ST
DOVER NJ
07801-4030
US

V. Phone/Fax

Practice location:
  • Phone: 973-442-1144
  • Fax: 973-366-3600
Mailing address:
  • Phone: 973-442-1144
  • Fax: 973-366-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID JEFREY GORDON
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 973-442-1144