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General NPI Number Information
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NPI Number | 1508107301
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Entity Type | Organization
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Legal Business Name | STAR PODIATRY PC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 119 E LAUREL RD
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City | STRATFORD
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State | NJ
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Zip | 08084-1324
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Country | US
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Telephone | 856-521-4132
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Fax |
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Provider Business Mailing Address
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Address Line | 155 CROSS SLOPE CT
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City | MANALAPAN
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State | NJ
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Zip | 07726-5412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | MICHAEL MOHARAN
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Credential | DMP
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Telephone | 856-521-4132
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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 | 25MD00312200
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License Number State | NJ
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