Healthcare Provider Details
I. General information
NPI: 1487083580
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
488 SCHOOLEYS MOUNTAIN RD
HACKETTSTOWN NJ
07840-4001
US
IV. Provider business mailing address
4633 HWY 9
HOWELL NJ
07731-3324
US
V. Phone/Fax
- Phone: 908-852-0229
- Fax:
- Phone:
- Fax:
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:
HAL
ORNSTEIN
Title or Position: PRESIDENT
Credential: DMP
Phone: 732-994-5333