Provider Demographics
NPI:1700398906
Name:JERSEY SHORE FOOT & ANKLE, P.C.
Entity Type:Organization
Organization Name:JERSEY SHORE FOOT & ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KACHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-269-1133
Mailing Address - Street 1:1 PELICAN DR STE 8
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1600
Mailing Address - Country:US
Mailing Address - Phone:732-269-1133
Mailing Address - Fax:732-269-7675
Practice Address - Street 1:1 PELICAN DR STE 8
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1600
Practice Address - Country:US
Practice Address - Phone:732-269-1133
Practice Address - Fax:732-269-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty