Provider Demographics
NPI:1518004936
Name:STEVEN B CANCELL D P M P A
Entity Type:Organization
Organization Name:STEVEN B CANCELL D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANCELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-456-8862
Mailing Address - Street 1:456 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-2343
Mailing Address - Country:US
Mailing Address - Phone:856-456-8862
Mailing Address - Fax:856-456-6272
Practice Address - Street 1:456 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-2343
Practice Address - Country:US
Practice Address - Phone:856-456-8862
Practice Address - Fax:856-456-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00213300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
107112Medicare PIN
NJU34032Medicare UPIN
NJ1028030001Medicare NSC
NJCA079300Medicare ID - Type Unspecified