Healthdrive Podiatry Group, PC
Organization Active NPI Podiatrist · Princeton, NJ
NPI 1013106533 · NPPES record last updated Dec 31, 2019
Key facts
- NPI
- 1013106533
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- HEALTHDRIVE PODIATRY GROUP, PC
- Practice address
- 103 Carnegie Ctr
Suite 300
Princeton, NJ 08540-6235 - Phone
- (888) 964-6681
- Fax
- (888) 662-0859
- NPI assigned
- Oct 22, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- HEALTHDRIVE PODIATRY GROUP, PC
Authorized official
- Name
- Dr. Shadi Adib Abboud, DPM
- Title
- Treasuer/Practice Director
- Phone
- (857) 255-0486
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 9
Practitioners 108
-
Noah Stark, DPM
-
Faysal Eqbal Siddiqui, MD; DPM
-
Dina Tsentserensky, DPM
-
Mark S Goldberg, D.P.M.
-
Samuel Udell, DPM
-
Magdalene Armanious, DPM
-
Shadi Adib Abboud, DPM
-
Edward Paul Abegg, D.P.M.
-
Jamey Ann Allen, DPM
-
Riya Altomonte, DPM
-
Joseph David Arbanas, D.P.M.
-
Bruce M Backer, D.P.M.
-
Keith A Beck, DPM
-
Brett Charles Becker, DPM
-
Dina Konetski Becker, DPM
-
Anthony J. Bianchi, DPM
-
Jason R Bickel, DPM
-
Rodney L. Bland, DPM
-
Laura Ashley Bohman, D.P.M.
-
Jeremy William Brouillette, D.P.M.
-
Jodee Brown, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Morristown Manor |
Skilled nursing facility | Adp of the SNF | Mar 7, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050810000144 | NJ | Part B Supplier - Clinic/Group Practice | 3375446958 |
Receives reassigned benefits from 6 practitioners Practice locations: Princeton, NJ |
National Provider Directory
- Tax ID family
- Healthdrive Podiatry GRP PC
- Part of
- Healthdrive Podiatry GRP PC
Locations
100 Crossing Blvd
Ste 500
Framingham, MA 01702
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
103 Carnegie Ctr
Suite 300
Princeton, NJ 08540-6235
Mailing address
100 Crossing Blvd
Suite 500
Framingham, MA 01702-5555
Phone (617) 964-6681
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DN8723 | Other | NJ | MEDICARE RAILROAD |
| 7065400 | Medicaid | NJ |
Other names
- HealthDrive Podiatry Group
Other providers in Princeton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.