Provider Demographics
NPI:1609863414
Name:OTTENHEIMER, JOSH BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:BARRY
Last Name:OTTENHEIMER
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 1:206 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5875
Mailing Address - Country:US
Mailing Address - Phone:609-240-2973
Mailing Address - Fax:609-799-0047
Practice Address - Street 1:263 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-3127
Practice Address - Country:US
Practice Address - Phone:609-799-0043
Practice Address - Fax:609-799-0047
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD0027960213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0774260001Medicare NSC
NJ083348N4HMedicare PIN
NJ0774260002Medicare NSC
NJ083348A7FMedicare PIN
NJV01325Medicare UPIN