Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD002635 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00263500 | NJ |
NPI | 1164461927 |
---|---|
Provider Name | Dr. Thomas John Feola |
First Address | Matawan, NJ 07747-9728 |
Second Address | Old Bridge, NJ 08857-9728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8476306 | (05) | NJ |
U81357 | (02) | NJ |