Provider Demographics
NPI:1972573871
Name:PODIATRIC SURGICAL ASSOCIATION OF CENTRAL JERSEY PA
Entity Type:Organization
Organization Name:PODIATRIC SURGICAL ASSOCIATION OF CENTRAL JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-730-8881
Mailing Address - Street 1:122 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1272
Mailing Address - Country:US
Mailing Address - Phone:908-730-8881
Mailing Address - Fax:908-730-6465
Practice Address - Street 1:122 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1272
Practice Address - Country:US
Practice Address - Phone:908-730-8881
Practice Address - Fax:908-730-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00119800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110887OtherCHN
489684OtherUNITED HEALTHCARE
F03784OtherHEALTHNET
0099717000OtherAMERIHEALTH
P00195654OtherRAILROAD MEDICARE
TS133OtherOXFORD
427979Medicare ID - Type Unspecified
489684OtherUNITED HEALTHCARE
F03784OtherHEALTHNET