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NPI Code Detail

MEDICARE: STUART JEFFREY PODOB DC

MEDICARE: STUART JEFFREY PODOB DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor9200NJ

General Provider Information

NPI Number : 1184712879
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART JEFFREY PODOB DC
Provider Business Mailing Address
First Line : 1700 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1253
Country : US
Telephone Number : 732-363-7900
Fax Number : 732-363-9341
Provider Business Practice Location Address
First Line : 1700 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1253
Country : US
Telephone Number : 732-363-7900
Fax Number : 732-363-9341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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Directions to “ STUART JEFFREY PODOB DC” Practice Location

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