Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MD002045 | NJ |
Y | 222Z00000X | Podiatrist | MD002045 | NJ |
N | 2081S0010X | Sports Medicine | MD002045 | NJ |
N | 213ES0000X | Sports Medicine | MD002045 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | MD002045 | NJ |
NPI | 1508830142 |
---|---|
Provider Name | Allen J Atheras |
First Address | Brick, NJ 08724-3229 |
Second Address | Brick, NJ 08724-3229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2K5454 | HEALTHNET (01) | NJ |
5083001 | (05) | NJ |
60006001 | HORIZON NJ HEALTH (01) | NJ |
P00139173 | RAILROAD (01) | NJ |
T323387 | (02) | NJ |
VS101 | OXFORD (01) | NJ |