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General NPI Number Information
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NPI Number | 1376575993
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Entity Type | Organization
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Legal Business Name | JERSEY SHORE PODIATRIC ASSOCIATES
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2130 HIGHWAY 35 BLDG C STE 312
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City | SEA GIRT
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State | NJ
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Zip | 08750-1010
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Country | US
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Telephone | 732-974-8200
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Fax | 732-974-0190
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Provider Business Mailing Address
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Address Line | PO BOX 825159
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City | PHILADELPHIA
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State | PA
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Zip | 19182-5159
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Country | US
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Telephone | 732-974-8200
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Fax | 732-974-0190
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. GENE S MIRKIN
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Credential | DPM
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Telephone | 410-266-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | MD2271
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License Number State | NJ
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