| NPI | 1790222875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL DAVID PETRANTO Authorized Official 732-505-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2022-12-12 |