Provider Demographics
NPI:1720797160
Name:NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP LLC
Entity type:Organization
Organization Name:NEW JERSEY PODIATRIC PHYSICIANS & SURGEONS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-994-5333
Mailing Address - Street 1:4633 HWY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4249 ROUTE 9 N UNIT B
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8308
Practice Address - Country:US
Practice Address - Phone:732-679-4330
Practice Address - Fax:732-679-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty