Provider Demographics
NPI:1407963887
Name:PODELL, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PODELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIVER RD
Mailing Address - Street 2:SUITE 1032 3RD FLOOR BLDG 10
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1034
Mailing Address - Country:US
Mailing Address - Phone:201-840-1980
Mailing Address - Fax:201-840-1987
Practice Address - Street 1:115 RIVER RD
Practice Address - Street 2:SUITE 1032 3RD FLOOR BLDG 10
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1034
Practice Address - Country:US
Practice Address - Phone:201-840-1980
Practice Address - Fax:201-840-1987
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor