Healthcare Provider Details

I. General information

NPI: 1104855477
Provider Name (Legal Business Name): ADVANTAGE FOOT CARE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B2 BRIER HILL COURT
EAST BRUNSWICK NJ
08816-3348
US

IV. Provider business mailing address

B2 BRIER HILL COURT
EAST BRUNSWICK NJ
08816-3348
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-9302
  • Fax: 732-613-4758
Mailing address:
  • Phone: 732-254-9302
  • Fax: 732-613-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00116600
License Number StateNJ

VIII. Authorized Official

Name: DR. WARREN A PASTERNACK
Title or Position: OWNER
Credential: D.P.M.
Phone: 732-254-9302