Healthcare Provider Details

I. General information

NPI: 1689632952
Provider Name (Legal Business Name): BRIAN JEFFREY SCHULTZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N COUNTY LINE RD STE H
JACKSON NJ
08527-4797
US

IV. Provider business mailing address

180 N COUNTY LINE RD STE H
JACKSON NJ
08527-4797
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-6611
  • Fax: 732-886-6702
Mailing address:
  • Phone: 732-367-6611
  • Fax: 732-886-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number005054
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00263800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: