Provider Demographics
NPI:1649212150
Name:CAFENGIU PODIATRY & SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:CAFENGIU PODIATRY & SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CAFENGIU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-810-8833
Mailing Address - Street 1:126 BORTONS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3055
Mailing Address - Country:US
Mailing Address - Phone:856-810-8833
Mailing Address - Fax:856-810-7811
Practice Address - Street 1:126 BORTONS LANDING RD
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3055
Practice Address - Country:US
Practice Address - Phone:856-810-8833
Practice Address - Fax:856-810-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02530213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8768803Medicaid
NJ050092Medicare ID - Type Unspecified
NJ5407870001Medicare NSC
NJU82740Medicare UPIN