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General NPI Number Information
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NPI Number | 1669490462
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Entity Type | Organization
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Legal Business Name | ATLANTIC SHORE PODIATRY,P.A.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 2303 SHORE RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-2148
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Country | US
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Telephone | 609-646-1991
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Fax | 609-646-7329
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Provider Business Mailing Address
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Address Line | 2303 SHORE RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-2148
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Country | US
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Telephone | 609-646-1991
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Fax | 609-646-7329
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM MICHAEL GUTMAN
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Credential | D.P.M.
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Telephone | 609-646-1991
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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 | 25MD00100700
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License Number State | NJ
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