Healthcare Provider Details

I. General information

NPI: 1730252859
Provider Name (Legal Business Name): LINCROFT FOOT AND ANKLE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1426
US

IV. Provider business mailing address

513 NEWMAN SPRINGS RD
LINCROFT NJ
07738-1426
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-6050
  • Fax: 732-741-4757
Mailing address:
  • Phone: 732-741-6050
  • Fax: 732-741-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00266000
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTHONY MICHAEL BURNIEWICZ
Title or Position: OWNER
Credential: DPM
Phone: 732-741-6050