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General NPI Number Information
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NPI Number | 1720517360
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Entity Type | Organization
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Legal Business Name | NORTH PLAINFIELD PODIATRY
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 654 MOUNT PROSPECT AVE # 301
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City | NEWARK
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State | NJ
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Zip | 07104-3110
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Country | US
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Telephone | 973-482-7007
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Fax | 973-482-9333
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Provider Business Mailing Address
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Address Line | 654 MOUNT PROSPECT AVE # 301
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City | NEWARK
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State | NJ
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Zip | 07104-3110
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Country | US
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Telephone | 973-482-7007
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Fax | 973-482-9333
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JAVIER PONCE
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Credential | DPM
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Telephone | 201-960-1512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 25MD00246800
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License Number State | NJ
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