Provider Demographics
NPI:1902815715
Name:FOOT & ANKLE CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FOOT & ANKLE CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VITO
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUZZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-868-1100
Mailing Address - Street 1:1948 WASHINGTON VALLEY RD
Mailing Address - Street 2:PO BOX 428
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-2016
Mailing Address - Country:US
Mailing Address - Phone:732-868-1100
Mailing Address - Fax:732-868-1277
Practice Address - Street 1:216 STELTON RD
Practice Address - Street 2:SUITE E3
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3284
Practice Address - Country:US
Practice Address - Phone:732-968-9494
Practice Address - Fax:732-968-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3243206Medicaid
NJPE516808Medicare ID - Type Unspecified
NJ3243206Medicaid