Provider Demographics
NPI:1124029533
Name:BRITTNER, RONALD L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:BRITTNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N BROADWAY
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1258
Mailing Address - Country:US
Mailing Address - Phone:856-678-6665
Mailing Address - Fax:856-678-7877
Practice Address - Street 1:390 N BROADWAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1258
Practice Address - Country:US
Practice Address - Phone:856-678-6665
Practice Address - Fax:856-678-7877
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00094200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2407906Medicaid
NJ4798700001Medicare NSC
NJ145604Medicare PIN
T77699Medicare UPIN