Provider Demographics
NPI:1043442593
Name:JERRIDO, JOAN M (DPM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:JERRIDO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1 FEDERAL ST
Mailing Address - Street 2:STE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9207
Practice Address - Country:US
Practice Address - Phone:856-270-4030
Practice Address - Fax:856-270-4044
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00300100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MD00300100OtherLICENSE