Healthcare Provider Details

I. General information

NPI: 1477813459
Provider Name (Legal Business Name): 11/11 CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HUDSON COVE
EDGEWATER NJ
07020-0000
US

IV. Provider business mailing address

125 HUDSON COVE
EDGEWATER NJ
07020-0000
US

V. Phone/Fax

Practice location:
  • Phone: 201-707-1200
  • Fax:
Mailing address:
  • Phone: 201-707-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00307400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN BERNSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 201-707-1200