Healthcare Provider Details

I. General information

NPI: 1952396335
Provider Name (Legal Business Name): CENTRAL JERSEY CENTER FOR FOOT & ANKLE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SHREWSBURY AVE SUITE 207
SHREWSBURY NJ
07702-4151
US

IV. Provider business mailing address

655 SHREWSBURY AVE SUITE 207
SHREWSBURY NJ
07702-4151
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-5500
  • Fax: 732-741-5560
Mailing address:
  • Phone: 732-741-5500
  • Fax: 732-741-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD01290
License Number StateNJ

VIII. Authorized Official

Name: DR. GEORGE J FAHOURY JR.
Title or Position: OWNER
Credential: DPM
Phone: 732-741-5500