Provider Demographics
NPI:1700029048
Name:HILLSBOROUGH PODIATRY GROUP, LLC
Entity Type:Organization
Organization Name:HILLSBOROUGH PODIATRY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:MIZRACHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-431-5901
Mailing Address - Street 1:719 ROUTE 206
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1536
Mailing Address - Country:US
Mailing Address - Phone:908-431-5901
Mailing Address - Fax:908-431-5906
Practice Address - Street 1:719 ROUTE 206
Practice Address - Street 2:SUITE 107
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1536
Practice Address - Country:US
Practice Address - Phone:908-431-5901
Practice Address - Fax:908-431-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00253800213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6257130001Medicare NSC
NJ026949Medicare PIN