Provider Demographics
NPI:1689663577
Name:GIRIMONTE, JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GIRIMONTE
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 1:2301 E EVESHAM RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4501
Mailing Address - Country:US
Mailing Address - Phone:856-772-1777
Mailing Address - Fax:856-772-1846
Practice Address - Street 1:2301 E EVESHAM RD
Practice Address - Street 2:SUITE 307
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4501
Practice Address - Country:US
Practice Address - Phone:856-772-1777
Practice Address - Fax:856-772-1846
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002588213E00000X
NJ25MD00258800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017779Medicaid
NJP00173938Medicare PIN
NJU92664Medicare UPIN
064533Medicare ID - Type Unspecified
NJ064533R63Medicare ID - Type Unspecified