Organization
BROADWAY FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON M REGIS MD (OWNER/PRESIDENT)
(609) 272-0655
Entity
Organization
Contact information
Practice address
22 N FRANKLIN BLVD, 2ND FLOOR, PLEASANTVILLE, NJ 08232-2547
(609) 272-0655
(609) 272-9317
Mailing address
22 N FRANKLIN BLVD, 2ND FLOOR, PLEASANTVILLE, NJ 08232-2547
(609) 272-0655
(609) 272-9317
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0329282
—
NJ
Enumeration date
04/25/2013
Last updated
04/25/2013
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