Healthcare Provider Details

I. General information

NPI: 1346678521
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS AND SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HURFFVILLE CROSSKEYS RD STE B6
SEWELL NJ
08080-2338
US

IV. Provider business mailing address

4633 HWY 9
HOWELL NJ
07731-3324
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-6082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00175200
License Number StateNJ

VIII. Authorized Official

Name: HAL ORNSTEIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 732-994-5333