Healthcare Provider Details

I. General information

NPI: 1629022306
Provider Name (Legal Business Name): JERSEY SHORE FOOT AND LEG CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 ROUTE 9 SUITE 1
BAYVILLE NJ
08721-1292
US

IV. Provider business mailing address

355 ROUTE 9 SUITE 1
BAYVILLE NJ
08721-1292
US

V. Phone/Fax

Practice location:
  • Phone: 732-269-1133
  • Fax: 732-269-7675
Mailing address:
  • Phone: 732-269-1133
  • Fax: 732-269-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00154800
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL GEORGE KACHMAR
Title or Position: DPM
Credential: DPM
Phone: 732-269-1133