Healthcare Provider Details

I. General information

NPI: 1194706192
Provider Name (Legal Business Name): WILLIAM ALAN LAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 JACK MARTIN BLVD
BRICK NJ
08724-7776
US

IV. Provider business mailing address

457 JACK MARTIN BLVD
BRICK NJ
08724-7776
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-7500
  • Fax: 732-840-2088
Mailing address:
  • Phone: 732-840-7500
  • Fax: 732-840-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA06269000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number25MA06269000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: