Healthcare Provider Details

I. General information

NPI: 1750495719
Provider Name (Legal Business Name): FOOT HEALTH CENTERS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MECHANIC ST
RED BANK NJ
07701-1869
US

IV. Provider business mailing address

52 BERLIN RD SUITE 5000
CHERRY HILL NJ
08034-3574
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-5525
  • Fax: 856-795-5994
Mailing address:
  • Phone: 856-795-1003
  • Fax: 856-795-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANINE COTTRILL
Title or Position: OFFICE MANAGER
Credential:
Phone: 856-795-1003