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General NPI Number Information
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NPI Number | 1477096410
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Entity Type | Organization
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Legal Business Name | JACKSON CENTER FOR FOOT AND ANKLE MEDICINE
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 728 BENNETTS MILLS RD
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City | JACKSON
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State | NJ
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Zip | 08527-3850
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Country | US
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Telephone | 732-833-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 728 BENNETTS MILLS RD
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City | JACKSON
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State | NJ
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Zip | 08527-3850
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Country | US
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Telephone | 732-833-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEITH ROSENTHAL
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Credential |
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Telephone | 732-833-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 25MD00240300
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License Number State | NJ
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