Healthcare Provider Details

I. General information

NPI: 1013203371
Provider Name (Legal Business Name): JERSEY SHORE PODIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ROUTE 88 STE 3
PT PLEASANT NJ
08742-2871
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 732-892-2100
  • Fax: 732-892-2111
Mailing address:
  • Phone: 732-892-2100
  • Fax: 732-892-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number25MD00282000
License Number StateNJ

VIII. Authorized Official

Name: CHAD R GRESKIWCZ
Title or Position: CREDENTIALING
Credential:
Phone: 314-909-1920