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General NPI Number Information
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NPI Number | 1508050139
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PODIATRY OF NORTH JERSEY
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 725 RIVER RD SUITE 201-A
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-840-7373
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Fax | 201-840-7383
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Provider Business Mailing Address
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Address Line | 725 RIVER RD SUITE 201-A
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City | EDGEWATER
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State | NJ
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Zip | 07020-1171
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Country | US
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Telephone | 201-840-7373
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Fax | 201-840-7383
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. CORINNE JEANETTE GEHEGAN
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Credential | DPM
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Telephone | 201-840-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00272100
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License Number State | NJ
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