Provider Demographics
NPI:1144262718
Name:CENTER FOR ADVANCED FOOT & ANKLE CARE
Entity type:Organization
Organization Name:CENTER FOR ADVANCED FOOT & ANKLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-580-0566
Mailing Address - Street 1:1195 RT 70
Mailing Address - Street 2:UNIT 12
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5946
Mailing Address - Country:US
Mailing Address - Phone:732-240-9223
Mailing Address - Fax:732-370-9222
Practice Address - Street 1:1195 RT 70
Practice Address - Street 2:UNIT 12
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-240-9223
Practice Address - Fax:732-370-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213ES0103X
NJ25MD00268500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099236Medicaid
NJ0099236Medicaid
NJ088101Medicare PIN
NJ5396900001Medicare NSC
NJDD6147Medicare PIN