Provider Demographics
NPI:1437211323
Name:BLOOMINGDALE PODIATRY CENTER, PA
Entity Type:Organization
Organization Name:BLOOMINGDALE PODIATRY CENTER, PA
Other - Org Name:BLOOMINGDALE PODIATRY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PALMAROZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-838-8885
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-0015
Mailing Address - Country:US
Mailing Address - Phone:973-838-8885
Mailing Address - Fax:973-283-1875
Practice Address - Street 1:9 CAREY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1407
Practice Address - Country:US
Practice Address - Phone:973-838-8885
Practice Address - Fax:973-283-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00175800213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0827428-004OtherCIGNA ID NUMBER
NJP378132OtherOXFORD HEALH CARE
NJF00962OtherHEALTHNET
NJF00962OtherHEALTHNET
NJP378132OtherOXFORD HEALH CARE