Provider Demographics
NPI:1578865150
Name:NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Entity Type:Organization
Organization Name:NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-994-5333
Mailing Address - Street 1:4633 HWY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3324
Mailing Address - Country:US
Mailing Address - Phone:973-994-5333
Mailing Address - Fax:973-777-8298
Practice Address - Street 1:1100 CLIFTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3631
Practice Address - Country:US
Practice Address - Phone:973-777-4650
Practice Address - Fax:973-777-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1914213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0843500001Medicare NSC