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General NPI Number Information
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NPI Number | 1689822975
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Entity Type | Organization
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Legal Business Name | MANAHAWKIN PODIATRY, LLC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 102 E BAY AVE SUITE H
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3175
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Country | US
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Telephone | 609-978-2950
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Fax | 609-978-2961
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Provider Business Mailing Address
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Address Line | 102 E BAY AVE SUITE H
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3175
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Country | US
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Telephone | 609-978-2950
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Fax | 609-978-2961
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Authorized Official
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Title or Position | PODIATRIST
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Name | MARK WILLIAM STEPHENS
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Credential | DPM
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Telephone | 609-978-2950
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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 | 25MD00225100
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License Number State | NJ
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