NPIMap

Organization Active NPI

Toms River Podiatrist

  • Foot & Ankle Surgery Podiatrist
  • Toms River, NJ
National Provider Identifier
1629732086
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
TOMS RIVER PODIATRIST
Practice address
104 Commons Way BLDG a
Toms River, NJ 08755-6426
Phone
(732) 349-1123
Fax
(732) 349-6549
NPI assigned
Oct 22, 2021
Last updated
Oct 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Kenneth Donovan, DPMNPI 1588804132
Title
Owner
Phone
(732) 814-7029

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X NU Primary

Addresses

Primary practice location

104 Commons Way BLDG a
Toms River, NJ 08755-6426

Mailing address

104 Commons Way BLDG a
Toms River, NJ 08755-6426
Phone (732) 349-1123

Other identifiers 1

IdentifierTypeStateIssuer
0231622MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kdonovan@advancedcarefootandankle.directmedgenehr.com Direct

National Provider Directory

National Provider Directory

Locations

104 Commons Way
Bldg A
Toms River, NJ 08755
Phone (732) 349-1123

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1629732086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 COMMONS WAY BLDG A",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087556426",
            "telephone_number": "732-349-1123",
            "fax_number": "732-349-6549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 COMMONS WAY BLDG A",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087556426",
            "telephone_number": "732-349-1123",
            "fax_number": "732-349-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOMS RIVER PODIATRIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "DONOVAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-814-7029",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0231622",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kdonovan@advancedcarefootandankle.directmedgenehr.com",
            "affiliation": "N",
            "endpointDescription": "MedgenEHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "104 Commons Way Bldg A",
            "city": "Toms River",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "087556426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Toms River, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.