Healthcare Provider Details

I. General information

NPI: 1104805647
Provider Name (Legal Business Name): CLINT C FERENZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 RT 34 SO STE D
MANASQUAN NJ
08736
US

IV. Provider business mailing address

2315 RT 34 SO STE D
MANASQUAN NJ
08736
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-0404
  • Fax: 732-449-4271
Mailing address:
  • Phone: 732-974-0404
  • Fax: 732-449-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA05295600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMA52956
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: