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General NPI Number Information
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NPI Number | 1952396335
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY CENTER FOR FOOT & ANKLE SURGERY, LLC
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 655 SHREWSBURY AVE SUITE 207
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4151
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Country | US
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Telephone | 732-741-5500
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Fax | 732-741-5560
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Provider Business Mailing Address
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Address Line | 655 SHREWSBURY AVE SUITE 207
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4151
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Country | US
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Telephone | 732-741-5500
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Fax | 732-741-5560
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE J FAHOURY JR.
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Credential | DPM
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Telephone | 732-741-5500
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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 | MD01290
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License Number State | NJ
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