Organization
THE JACKSON CENTER FOR FOOT AND ANKLE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE KASZUBA (OFFICE MANAGER)
(732) 833-2800
Entity
Organization
Contact information
Practice address
35 BEAVERSON BLVD, 1, BRICK, NJ 08723-7812
(732) 477-0441
Mailing address
35 BEAVERSON BLVD, BLDG 1, BRICK, NJ 08723-7812
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
25MD00240300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7323107
—
NJ
Enumeration date
04/13/2017
Last updated
04/13/2017
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