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General NPI Number Information
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NPI Number | 1891899092
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Entity Type | Organization
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Legal Business Name | GIBBONS FOOT & ANKLE GROUP LLC
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 8 AUER COURT SUITE C & D
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-254-2609
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Fax | 732-238-6269
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Provider Business Mailing Address
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Address Line | 8 AUER COURT SUITE C & D
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-254-2609
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Fax | 732-238-6269
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | THOMAS J GIBBONS
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Credential | DPM
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Telephone | 732-254-2609
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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 | 25MD00194800
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License Number State | NJ
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