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General NPI Number Information
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NPI Number | 1346989712
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Entity Type | Organization
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Legal Business Name | SKYLINE PODIATRY
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 52 SKYLINE DR
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City | RINGWOOD
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State | NJ
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Zip | 07456-2020
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Country | US
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Telephone | 631-804-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 52 SKYLINE DR
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City | RINGWOOD
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State | NJ
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Zip | 07456-2020
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Country | US
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Telephone | 973-962-7775
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Fax | 973-869-4144
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Authorized Official
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Title or Position | PODIATRIST
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Name | JUSTIN DONOVAN
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Credential | DPM
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Telephone | 973-962-7775
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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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