Healthcare Provider Details

I. General information

NPI: 1578865150
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CLIFTON AVE SUITE C
CLIFTON NJ
07013-3631
US

IV. Provider business mailing address

4633 HWY 9
HOWELL NJ
07731-3324
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-4650
  • Fax: 973-777-8298
Mailing address:
  • Phone: 973-994-5333
  • Fax: 973-777-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD1914
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD1914
License Number StateNJ

VIII. Authorized Official

Name: DR. HAL ORNSTEIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 732-994-5333