Provider Demographics
NPI:1447896709
Name:FOOT CARE OF NEW JERSEY LLC
Entity type:Organization
Organization Name:FOOT CARE OF NEW JERSEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AQSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-349-3432
Mailing Address - Street 1:2211 BRISTOL STATION CT
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-3085
Mailing Address - Country:US
Mailing Address - Phone:732-993-5040
Mailing Address - Fax:732-587-5486
Practice Address - Street 1:835 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1815
Practice Address - Country:US
Practice Address - Phone:908-652-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty