Healthcare Provider Details

I. General information

NPI: 1801045919
Provider Name (Legal Business Name): ASSOCIATES IN PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 ROUTE 27
KINGSTON NJ
08528-9601
US

IV. Provider business mailing address

318 CHESTNUT ST
ROSELLE PARK NJ
07204-1904
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-8333
  • Fax: 609-924-8663
Mailing address:
  • Phone: 908-687-5757
  • Fax: 908-241-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD001896
License Number StateNJ

VIII. Authorized Official

Name: MRS. EILEEN FRANCES QUINN
Title or Position: OFFICE MANAGER
Credential:
Phone: 908-687-5757