MEDICARE: GEORGE M MUCHEN DPM

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	MD001252	NJ

General Provider Information

NPI Number	:	1346243334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE M MUCHEN DPM

Provider Business Mailing Address
First Line	:	163 NORTH AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-3125
Country	:	US
Telephone Number	:	908-355-4365
Fax Number	:	908-355-4365

Provider Business Practice Location Address
First Line	:	163 NORTH AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-3125
Country	:	US
Telephone Number	:	908-355-4365
Fax Number	:	908-355-4365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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