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General NPI Number Information
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NPI Number | 1730559196
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF NEW JERSEY LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 309 ROCK AVE
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City | GREEN BROOK
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State | NJ
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Zip | 08812-2616
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Country | US
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Telephone | 973-837-6352
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Fax |
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Provider Business Mailing Address
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Address Line | 49 PROSPECT ST
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-1544
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Country | US
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Telephone | 973-837-6352
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HENRY BORRELLI
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Credential | DPM
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Telephone | 973-837-6352
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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 | 25MD00227300
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License Number State | NJ
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