Provider Demographics
NPI:1689821043
Name:BRIAN K GOTCHEL DPM
Entity Type:Organization
Organization Name:BRIAN K GOTCHEL DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-848-0500
Mailing Address - Street 1:636 KINGS HWY STE A
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:636 KINGS HWY STE A
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3164
Practice Address - Country:US
Practice Address - Phone:856-848-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02066213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0553530001Medicare NSC