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General NPI Number Information
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NPI Number | 1093886038
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Entity Type | Organization
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Legal Business Name | OLD HOOK PODIATRY ASSOC PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 452 OLD HOOK RD 2ND FL
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City | EMERSON
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State | NJ
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Zip | 07630-1381
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Country | US
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Telephone | 201-599-1336
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Fax | 201-599-1386
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Provider Business Mailing Address
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Address Line | 452 OLD HOOK RD 2ND FL
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City | EMERSON
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State | NJ
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Zip | 07630-1381
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Country | US
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Telephone | 201-599-1336
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Fax | 201-599-1386
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SUSAN E DOERNER
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Credential |
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Telephone | 201-391-6731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 25MD00273200
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License Number State | NJ
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