Provider Demographics
NPI:1427043199
Name:LIMIDO, TERESA J (DPM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:LIMIDO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1954
Mailing Address - Country:US
Mailing Address - Phone:201-368-0244
Mailing Address - Fax:
Practice Address - Street 1:90 MILLBURN AVE
Practice Address - Street 2:STE 203
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1933
Practice Address - Country:US
Practice Address - Phone:973-762-9294
Practice Address - Fax:973-762-9262
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00269100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003867Medicaid
067668Medicare PIN
U94224Medicare UPIN