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General NPI Number Information
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NPI Number | 1144262718
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Entity Type | Organization
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Legal Business Name | CENTER FOR ADVANCED FOOT & ANKLE CARE
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1195 RT 70 UNIT 12
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone | 732-240-9223
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Fax | 732-370-9222
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Provider Business Mailing Address
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Address Line | 1195 RT 70 UNIT 12
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5946
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Country | US
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Telephone | 732-240-9223
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Fax | 732-370-9222
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN ROBERT STODDARD
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Credential | DPM
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Telephone | 732-580-0566
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00268500
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License Number State | NJ
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