Provider Demographics
NPI:1659823508
Name:MERCER-OCEAN PODIATRY
Entity Type:Organization
Organization Name:MERCER-OCEAN PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-557-4266
Mailing Address - Street 1:202 ROUTE 37 W STE 4
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8055
Mailing Address - Country:US
Mailing Address - Phone:732-688-8370
Mailing Address - Fax:732-557-5001
Practice Address - Street 1:2103 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-2641
Practice Address - Country:US
Practice Address - Phone:609-585-3200
Practice Address - Fax:609-586-3186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCER-OCEAN PODIATRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00240900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDW8603OtherGROUP PTAN
NJ503446OtherMEDICARE PTAN MERCER OCEAN PODIATRY
NJ066771OtherMEDICARE PTAN FJ KILLIAN
NJ1508222746OtherGROUP NPI
NJ503446OtherMEDICARE PTAN MERCER OCEAN PODIATRY