Organization
BERGENLINE FOOT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAVIER R PONCE DPM (OWNER)
(201) 283-6849
Entity
Organization
Contact information
Practice address
4500 BERGENLINE AVE, UNION CITY, NJ 07087-2733
(201) 283-6849
Mailing address
330 WASHINGTON ST # 181, HOBOKEN, NJ 07030-4883
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00246800
NJ
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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