Healthcare Provider Details

I. General information

NPI: 1538142187
Provider Name (Legal Business Name): FREDERICK CHAIM EZON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HIGHWAY 35
OCEAN NJ
07712-4048
US

IV. Provider business mailing address

1025 HIGHWAY 35
OCEAN NJ
07712-4048
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-8200
  • Fax: 732-531-8201
Mailing address:
  • Phone: 732-531-8200
  • Fax: 732-531-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA03285800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA32858
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: