Healthcare Provider Details

I. General information

NPI: 1134559925
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 AMBOY AVE
EDISON NJ
08837-3584
US

IV. Provider business mailing address

4633 HWY 9
HOWELL NJ
07731-3324
US

V. Phone/Fax

Practice location:
  • Phone: 732-903-2500
  • Fax:
Mailing address:
  • Phone: 732-994-5333
  • Fax: 732-994-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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