=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609883370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT SPECIALISTS OF MOORESTOWN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 N CHURCH ST STE 125
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-866-8998
-----------------------------------------------------
Fax | 856-866-9746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 N CHURCH ST SUITE 125
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-866-8998
-----------------------------------------------------
Fax | 856-866-9746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH MICHAEL SANTOMAURO JR.
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 856-866-8998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 25MD00287500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------