Healthcare Provider Details

I. General information

NPI: 1194839274
Provider Name (Legal Business Name): CHRISTOPHER J MULLIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CAMBRIDGE DR SUITE D
ABERDEEN NJ
07747-2256
US

IV. Provider business mailing address

20 CAMBRIDGE DR SUITE D
ABERDEEN NJ
07747-2256
US

V. Phone/Fax

Practice location:
  • Phone: 732-566-2841
  • Fax: 732-566-1264
Mailing address:
  • Phone: 732-566-2841
  • Fax: 732-566-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00253600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN005455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: