Healthcare Provider Details

I. General information

NPI: 1326496217
Provider Name (Legal Business Name): SOMERSET FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MONROE ST
BRIDGEWATER NJ
08807-3043
US

IV. Provider business mailing address

9 MONROE ST
BRIDGEWATER NJ
08807-3043
US

V. Phone/Fax

Practice location:
  • Phone: 908-231-1114
  • Fax: 908-252-1930
Mailing address:
  • Phone: 908-231-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00160100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PATRICK THIELE
Title or Position: SOLE OWNER
Credential: DPM
Phone: 908-231-1114