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NPI Code Detail

MEDICARE: FOOT CLINIC PC

MEDICARE: FOOT CLINIC PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatristMD25000869NJ

General Provider Information

NPI Number : 1285898379
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOT CLINIC PC
Provider Business Mailing Address
First Line : 118 COLUMBIA TPKE
Second Line :
City : FLORHAM PARK
State : NJ
Zip : 07932-2106
Country : US
Telephone Number : 973-514-2000
Fax Number : 973-514-1114
Provider Business Practice Location Address
First Line : 118 COLUMBIA TPKE
Second Line :
City : FLORHAM PARK
State : NJ
Zip : 07932-2106
Country : US
Telephone Number : 973-514-2000
Fax Number : 973-514-1114
Authorized Official
Title or Position : PRESIDENT
Name : DR. BARRY N KANOFF
Credential : DPM
Telephone Number : 973-514-2000
Provider Enumeration Date : 07/17/2008
Last Update Date : 07/17/2008

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Directions to “FOOT CLINIC PC ” Practice Location

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