Healthcare Provider Details

I. General information

NPI: 1346781614
Provider Name (Legal Business Name): WOODBURY FOOT CARE CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MANTUA PIKE SUITE10
WOODBURY HEIGHTS NJ
08097-1141
US

IV. Provider business mailing address

722 MANTUA PIKE SUITE10
WOODBURY HEIGHTS NJ
08097-1141
US

V. Phone/Fax

Practice location:
  • Phone: 856-384-1333
  • Fax: 856-384-1297
Mailing address:
  • Phone: 856-384-1333
  • Fax: 856-384-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00208400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00328100
License Number StateNJ

VIII. Authorized Official

Name: DR. AMY BETH HERSKOWITZ
Title or Position: CEO
Credential: DPM
Phone: 856-384-1333