1144326448 NPI number — BRIAN J SCHULTZ, D.P.M. , P.A.

Table of content: (NPI 1144326448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144326448 NPI number — BRIAN J SCHULTZ, D.P.M. , P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN J SCHULTZ, D.P.M. , P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144326448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 COTTONWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-367-6611
Provider Business Mailing Address Fax Number:
732-886-6702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 W COUNTY LINE RD
Provider Second Line Business Practice Location Address:
BUILDING 1
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08527-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-367-6611
Provider Business Practice Location Address Fax Number:
732-886-6702
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
JEFFREY
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
732-367-6611

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  25MD00263800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0103829 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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