Provider Demographics
NPI:1689632952
Name:SCHULTZ, BRIAN JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFREY
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N COUNTY LINE RD STE H
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4797
Mailing Address - Country:US
Mailing Address - Phone:732-367-6611
Mailing Address - Fax:732-886-6702
Practice Address - Street 1:180 N COUNTY LINE RD STE H
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4797
Practice Address - Country:US
Practice Address - Phone:732-367-6611
Practice Address - Fax:732-886-6702
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005054213EP1101X
NJ25MD00263800213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01518643Medicaid
NYPPWX11Medicare PIN
NY01518643Medicaid