Organization
FORKED RIVER MEDICAL SPECIALISTS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE ENDE D.O. (PRESIDENT)
(609) 693-1992
Entity
Organization
Contact information
Practice address
422 WEST LACEY ROAD, FORKED RIVER, NJ 08731-2518
(609) 693-1992
(609) 971-3199
Mailing address
P.O. BOX 567, FORKED RIVER, NJ 08731-0567
(609) 693-1992
(609) 971-3199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0659703
—
NJ
01
—
123723
PTAN
NJ
Enumeration date
08/15/2006
Last updated
11/01/2013
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