Provider Demographics
NPI:1013203371
Name:JERSEY SHORE PODIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:JERSEY SHORE PODIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-974-8200
Mailing Address - Street 1:2130 HIGHWAY 35
Mailing Address - Street 2:BLDG C STE 312
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1010
Mailing Address - Country:US
Mailing Address - Phone:732-974-8200
Mailing Address - Fax:732-974-0190
Practice Address - Street 1:1115 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-2384
Practice Address - Country:US
Practice Address - Phone:732-892-2100
Practice Address - Fax:732-892-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00282000332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6920101Medicaid