Healthcare Provider Details

I. General information

NPI: 1144262718
Provider Name (Legal Business Name): CENTER FOR ADVANCED FOOT & ANKLE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 RT 70 UNIT 12
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

1195 RT 70 UNIT 12
LAKEWOOD NJ
08701-5946
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-9223
  • Fax: 732-370-9222
Mailing address:
  • Phone: 732-240-9223
  • Fax: 732-370-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00268500
License Number StateNJ

VIII. Authorized Official

Name: DR. SEAN ROBERT STODDARD
Title or Position: OWNER
Credential: DPM
Phone: 732-580-0566