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General NPI Number Information
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NPI Number | 1578208237
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Entity Type | Organization
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Legal Business Name | PRIMARY PODIATRY LLC
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 35 BARTMAN RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-4635
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Country | US
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Telephone | 201-551-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 159 SUMMIT AVE APT 2
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City | LYNDHURST
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State | NJ
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Zip | 07071-1283
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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 | PHYSICIAN
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Name | JI YANG
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Credential |
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Telephone | 201-551-1117
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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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