=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942025267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2024
-----------------------------------------------------
Last Update Date | 11/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 719 N BEERS ST STE 2A
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-739-3230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4633 HWY 9
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07731-3324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-994-5333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | CHERYL MARTINETTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-994-5333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------