Provider Demographics
NPI:1265688774
Name:JERSEY SHORE FOOT AND LEG CENT
Entity Type:Organization
Organization Name:JERSEY SHORE FOOT AND LEG CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHLHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-769-5337
Mailing Address - Street 1:10 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5803
Mailing Address - Country:US
Mailing Address - Phone:908-769-5337
Mailing Address - Fax:
Practice Address - Street 1:10 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5803
Practice Address - Country:US
Practice Address - Phone:908-769-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1954213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679589261OtherHORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY