Provider Demographics
NPI:1164608808
Name:CHARLES F BIRK DPM PA
Entity Type:Organization
Organization Name:CHARLES F BIRK DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-465-1644
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0538
Mailing Address - Country:US
Mailing Address - Phone:609-465-1644
Mailing Address - Fax:609-465-6180
Practice Address - Street 1:29 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2219
Practice Address - Country:US
Practice Address - Phone:609-465-1644
Practice Address - Fax:609-465-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00182900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162250001Medicare NSC