Individual
DR. GARY J. FADEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
216 JACK MARTIN BLVD, SUITE D-4, BRICK, NJ 08724-7771
(732) 458-8383
(732) 458-8965
Mailing address
216 JACK MARTIN BLVD, SUITE D-4, BRICK, NJ 08724-7771
(732) 458-8383
(732) 458-8965
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00114700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205671
UNIFORMED SERVICES
NJ
01
—
222332380
TAX ID#
NJ
05
—
3011402
—
NJ
01
—
P404738
OXFORD
NJ
Enumeration date
08/09/2006
Last updated
11/26/2007
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