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General NPI Number Information
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NPI Number | 1104855477
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Entity Type | Organization
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Legal Business Name | ADVANTAGE FOOT CARE CENTERS LLC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 12/31/2010
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Provider Practice Location Address
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Address Line | B2 BRIER HILL COURT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3348
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Country | US
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Telephone | 732-254-9302
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Fax | 732-613-4758
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Provider Business Mailing Address
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Address Line | B2 BRIER HILL COURT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3348
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Country | US
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Telephone | 732-254-9302
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Fax | 732-613-4758
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Authorized Official
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Title or Position | OWNER
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Name | DR. WARREN A PASTERNACK
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Credential | D.P.M.
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Telephone | 732-254-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00116600
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License Number State | NJ
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