Healthcare Provider Details

I. General information

NPI: 1427227677
Provider Name (Legal Business Name): PARK AVENUE FAMILY FOOT CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PARK AVE
PLAINFIELD NJ
07060-3228
US

IV. Provider business mailing address

1250 PARK AVE
PLAINFIELD NJ
07060-3228
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-0707
  • Fax: 908-755-9204
Mailing address:
  • Phone: 908-755-0707
  • Fax: 908-755-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00225800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD L CORBIN
Title or Position: DOCTOR
Credential: D.P.M
Phone: 908-755-0707