Provider Demographics
NPI:1871914531
Name:NORTHFIELD PODIATRY PC
Entity type:Organization
Organization Name:NORTHFIELD PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-243-2666
Mailing Address - Street 1:634 EAGLE ROCK AVE
Mailing Address - Street 2:UNIT 201
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-6800
Mailing Address - Country:US
Mailing Address - Phone:973-243-2666
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:SUITE 350
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5341
Practice Address - Country:US
Practice Address - Phone:973-243-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00220000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty