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General NPI Number Information
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NPI Number | 1972573871
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Entity Type | Organization
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Legal Business Name | PODIATRIC SURGICAL ASSOCIATION OF CENTRAL JERSEY PA
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 122 W MAIN ST
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City | CLINTON
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State | NJ
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Zip | 08809-1272
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Country | US
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Telephone | 908-730-8881
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Fax | 908-730-6465
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Provider Business Mailing Address
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Address Line | 122 W MAIN ST
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City | CLINTON
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State | NJ
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Zip | 08809-1272
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Country | US
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Telephone | 908-730-8881
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Fax | 908-730-6465
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY COHEN
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Credential | DPM
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Telephone | 908-730-8881
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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 | 25MD00119800
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License Number State | NJ
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