Healthcare Provider Details

I. General information

NPI: 1669771242
Provider Name (Legal Business Name): LIVINGSTON AVENUE FOOT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

IV. Provider business mailing address

602 LIVINGSTON AVE
NORTH BRUNSWICK NJ
08902-2443
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-1377
  • Fax: 732-246-0858
Mailing address:
  • Phone: 732-246-1377
  • Fax: 732-246-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DEVINDRA POONAI
Title or Position: OWNER
Credential: D.P.M.
Phone: 732-246-1377