Provider Demographics
NPI:1144326448
Name:BRIAN J SCHULTZ, D.P.M. , P.A.
Entity type:Organization
Organization Name:BRIAN J SCHULTZ, D.P.M. , P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-367-6611
Mailing Address - Street 1:19 COTTONWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527
Mailing Address - Country:US
Mailing Address - Phone:732-367-6611
Mailing Address - Fax:732-886-6702
Practice Address - Street 1:2110 W COUNTY LINE RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2049
Practice Address - Country:US
Practice Address - Phone:732-367-6611
Practice Address - Fax:732-886-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00263800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0103829Medicaid
NJ0103829Medicaid
NJ107573Medicare PIN
NJ5842650001Medicare NSC