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General NPI Number Information
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NPI Number | 1972943074
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Entity Type | Individual
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Provider Name | SANDY MARIE FOUKARAKIS P.A
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Gender | Female
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 425 JACK MARTIN BLVD OCEAN MEDICAL CENTER
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City | BRICK
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State | NJ
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Zip | 08724-7732
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Country | US
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Telephone | 732-836-4380
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Fax |
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Provider Business Mailing Address
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Address Line | 83 BROOKFIELD DR
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City | JACKSON
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State | NJ
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Zip | 08527-3886
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Country | US
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Telephone | 848-992-1722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00311100
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License Number State | NJ
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