Provider Demographics
NPI:1275721946
Name:KING, JOHN C (DPM, DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:DPM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:732-643-2070
Mailing Address - Fax:732-643-2015
Practice Address - Street 1:3000 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-2400
Practice Address - Country:US
Practice Address - Phone:732-643-2070
Practice Address - Fax:732-643-2015
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00669600111N00000X
NYN006213213E00000X
OH003454213E00000X
NJ25MD00294000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02937497Medicaid
NYP010306213OtherBLUE CROSS/BLUE SHIELD
NYP010306213OtherBLUE CROSS/BLUE SHIELD
NY02937497Medicaid
1275721946Medicare NSC
P00478658Medicare PIN