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General NPI Number Information
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NPI Number | 1285369272
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Entity Type | Organization
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Legal Business Name | NJ MINIMALLY INVASIVE PODIATRIC SURGERY P.C.
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 173 KINGSBURY CT
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City | NAZARETH
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State | PA
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Zip | 18064-1147
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Country | US
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Telephone | 201-701-1595
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Fax | 212-867-3845
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Provider Business Mailing Address
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Address Line | 173 KINGSBURY CT
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City | NAZARETH
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State | PA
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Zip | 18064-1147
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Country | US
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Telephone | 201-598-1184
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | JOSE ELIGIO GRULLON JR.
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Credential | DPM
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Telephone | 201-598-1184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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