Organization
BROADWAY FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON M. REGIS MD (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 NORTH FRANKLIN BLVD, 2ND FLOOR, PLEASANTVILLE, NJ 08232-2547
(609) 272-0655
(609) 272-9317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5569605
—
NJ
Enumeration date
06/07/2006
Last updated
08/30/2013
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