Provider Demographics
NPI:1578655965
Name:PARKER, DAVID ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:PARKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 BLOOMFIELD AVE.
Mailing Address - Street 2:STE. 1
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1368
Mailing Address - Country:US
Mailing Address - Phone:973-239-8849
Mailing Address - Fax:
Practice Address - Street 1:741 BLOOMFIELD AVE.
Practice Address - Street 2:STE. 1
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1368
Practice Address - Country:US
Practice Address - Phone:973-239-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001728213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0903302Medicaid
T45068Medicare UPIN
NJ0903302Medicaid
NJ448458Medicare PIN