Provider Demographics
NPI:1174559215
Name:RECONSTRUCTIVE FOOT AND ANKLE SURGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:RECONSTRUCTIVE FOOT AND ANKLE SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-825-9009
Mailing Address - Street 1:501 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5424
Mailing Address - Country:US
Mailing Address - Phone:856-232-9286
Mailing Address - Fax:
Practice Address - Street 1:1600 HIGH ST N
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1922
Practice Address - Country:US
Practice Address - Phone:856-825-9009
Practice Address - Fax:856-825-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00234800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0479397000OtherAMERIHEALTH HMO
NJ000536893OtherHIGHMARK BLUE SHIELD
NJ7446802Medicaid
NJ0479397000OtherAMERIHEALTH HMO
NJ99000514Medicare PIN
NJ1224350001Medicare NSC