Provider Demographics
NPI:1952396335
Name:CENTRAL JERSEY CENTER FOR FOOT & ANKLE SURGERY, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY CENTER FOR FOOT & ANKLE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAHOURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-741-5500
Mailing Address - Street 1:655 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4151
Mailing Address - Country:US
Mailing Address - Phone:732-741-5500
Mailing Address - Fax:732-741-5560
Practice Address - Street 1:655 SHREWSBURY AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4151
Practice Address - Country:US
Practice Address - Phone:732-741-5500
Practice Address - Fax:732-741-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01290213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPC1661OtherEMPIRE BLUE CROSS BLUE SH
NJMS306OtherOXFORD HEALTH PLAN
NJ480028355OtherRAILROAD MEDICARE
NJ0K8685OtherHEALTH NET
NJ1393600Medicaid
NJ119768Medicare PIN
NJT44727Medicare UPIN
NJ5458240001Medicare NSC