Healthcare Provider Details
I. General information
NPI: 1396173324
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/30/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
188 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2412
US
IV. Provider business mailing address
4633 HWY 9
HOWELL NJ
07731-3324
US
V. Phone/Fax
- Phone: 908-576-0880
- Fax: 877-356-1107
- Phone: 732-994-5333
- Fax: 732-994-5336
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213ES0103X |
| Taxonomy | Foot & Ankle Surgery Podiatrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HAL
ORNSTEIN
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 732-944-5333