| Organization Name: | JERSEY SHORE PODIATRIC ASSOCIATES |
| NPI Number: | 1376575993 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES PATRICK SULLIVAN (OWNER/PRESIDENT) |
| Mailing Address: | 2130 Highway 35 Bldg C Ste 312 Sea Girt |
| State: | NJ US |
| Postal Code: | 087501010 |
| Phone Number: | 7329748200 |
| Fax Number: | 7329740190 |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | MD2271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |