Healthcare Provider Details

I. General information

NPI: 1982141065
Provider Name (Legal Business Name): OCEAN COUNTY FOOT & ANKLE SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 LACEY RD
FORKED RIVER NJ
08731-2104
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-3202
  • Fax: 609-639-7865
Mailing address:
  • Phone: 732-505-4500
  • Fax: 732-505-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GENE MIRKIN
Title or Position: AUTHORIZED OFFICIAL
Credential: D.P.M.
Phone: 410-266-7575