Doctor Name: | DR. JACK TESTA |
NPI Number: | 1013985951 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | MD00160000 |
Business Practice Address: | 4808 Bergenline Ave Suite 202 Union City, NJ - 070875172 |
Business Phone Number: | 2018630036 |
Business Fax Number: | 2018630727 |
Mailing Address: | 4808 Bergenline Ave, Ste 202 UNION CITY |
State: | NJ |
Postal Code: | 070875172 |
Phone Number: | 2018630036 |
Fax Number: | 2018630727 |
NPI Enumeration Date: | 03/08/2006 |
NPI Last Update Date: | 07/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0131X |
License Number: | MD00160000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot Surgery |
Taxonomy Definition: |