Healthcare Provider Details

I. General information

NPI: 1467823765
Provider Name (Legal Business Name): NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS WAY E SUITE D6
SEWELL NJ
08080-2237
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: 732-994-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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