Healthcare Provider Details

I. General information

NPI: 1619980273
Provider Name (Legal Business Name): H.B. PODIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ROCK AVE
GREEN BROOK NJ
08812-2616
US

IV. Provider business mailing address

366 UPPER MOUNTAIN AVE
UPPER MONTCLAIR NJ
07043-1436
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00227300
License Number StateNJ

VIII. Authorized Official

Name: DR. HENRY BORRELLI
Title or Position: PRESIDENT
Credential: DPM
Phone: 732-968-3900