Eastern Pedorthics, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

EASTERN PEDORTHICS, INC.

Practice address

7 Route 31 N
Pennington, NJ 08534-1612

Phone

(609) 737-7701

Fax

(609) 737-7705

NPI assigned

Jan 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Stout, CPED

Title

Owner

Phone

(609) 737-7701

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1043356256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 ROUTE 31 N",
            "city": "PENNINGTON",
            "state": "NJ",
            "postal_code": "085341612",
            "telephone_number": "609-737-7701",
            "fax_number": "609-737-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ROUTE 31 N",
            "city": "PENNINGTON",
            "state": "NJ",
            "postal_code": "085341612",
            "telephone_number": "609-737-7701",
            "fax_number": "609-737-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PEDORTHICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-737-7701",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6757502",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "823763",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dungarvin New Jersey, LLC- Freedom Apt 103
• Dungarvin New Jersey, LLC- Freedom Apt 104
• Dungarvin New Jersey, LLC- Freedom Apt 105
• Deeca Joyceann Dunham, RN
• Sviatlana Dvorkina
• Joshua Matthew Eccles, MD
• Angie Carolina Echeverry, NP
• Samantha Eckardt, RD
• Joshua Aaron Eisenberg, MD
• Deena Elkafrawi, MD

• All providers in Pennington, NJ
• Durable Medical Equipment & Medical Supplies in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.