Provider Demographics
NPI:1235194192
Name:JOSOVITZ, MICHAEL S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:JOSOVITZ
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 1:588 EAST BAY AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3392
Mailing Address - Country:US
Mailing Address - Phone:609-597-0550
Mailing Address - Fax:609-597-9325
Practice Address - Street 1:588 EAST BAY AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3392
Practice Address - Country:US
Practice Address - Phone:609-597-0550
Practice Address - Fax:609-597-9325
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00181200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6730210001OtherPTAN
NJ480009468OtherRAILROAD MEDICARE
NJ3452506Medicaid
NJ6730210001Medicare NSC
NJ3452506Medicaid
NJ500034Medicare PIN