Healthcare Provider Details

I. General information

NPI: 1982900296
Provider Name (Legal Business Name): IRVING D STROUSE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 3RD AVE SUTIE 504
LONG BRANCH NJ
07740-6211
US

IV. Provider business mailing address

279 3RD AVE SUTIE 504
LONG BRANCH NJ
07740-6211
US

V. Phone/Fax

Practice location:
  • Phone: 732-229-4333
  • Fax: 732-571-1937
Mailing address:
  • Phone: 732-229-4333
  • Fax: 732-571-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA02268800
License Number StateNJ

VIII. Authorized Official

Name: IRVING D STROUSE
Title or Position: PRESIDENT
Credential: MD
Phone: 732-229-4333