Provider Demographics
NPI:1851337125
Name:THALER, GEORGE LEWIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEWIS
Last Name:THALER
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 1:701 TENNENT RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3193
Mailing Address - Country:US
Mailing Address - Phone:732-536-9593
Mailing Address - Fax:732-536-5840
Practice Address - Street 1:701 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3193
Practice Address - Country:US
Practice Address - Phone:732-536-9593
Practice Address - Fax:732-536-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1018213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1851337125OtherNPI
NJ0321310001Medicare NSC
NJ044834Medicare ID - Type Unspecified