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General NPI Number Information
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NPI Number | 1972657310
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Entity Type | Organization
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Legal Business Name | BAYSIDE FOOT & ANKLE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 BAY AVE STE 103
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City | SOMERS POINT
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State | NJ
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Zip | 08244
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Country | US
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Telephone | 609-926-7006
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Fax | 609-926-7016
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Provider Business Mailing Address
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Address Line | 501 BAY AVE STE 103
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City | SOMERS POINT
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State | NJ
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Zip | 08244
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Country | US
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Telephone | 609-926-7006
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Fax | 609-926-7016
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Authorized Official
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Title or Position | OM
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Name | TERRY LINDEMUTH
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Credential |
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Telephone | 609-926-7006
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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 | 25MD00248000
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License Number State | NJ
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