Healthcare Provider Details

I. General information

NPI: 1629127832
Provider Name (Legal Business Name): TENDER FOOT CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROSPECT AVE 12M
HACKENSACK NJ
07601-2518
US

IV. Provider business mailing address

140 PROSPECT AVE 12M
HACKENSACK NJ
07601-2518
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-3656
  • Fax: 201-342-2414
Mailing address:
  • Phone: 201-342-3656
  • Fax: 201-342-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD00875
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7202105
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. STEPHEN N HIRSCHBERG
Title or Position: PODIATRIST
Credential: DPM
Phone: 201-342-3656