Provider Demographics
NPI:1730272790
Name:TWIN RIVERS PODIATRIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:TWIN RIVERS PODIATRIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-213-3553
Mailing Address - Street 1:481 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1574
Mailing Address - Country:US
Mailing Address - Phone:908-213-3553
Mailing Address - Fax:908-213-3532
Practice Address - Street 1:481 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1574
Practice Address - Country:US
Practice Address - Phone:908-213-3553
Practice Address - Fax:908-213-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069949Medicare ID - Type Unspecified