Provider Demographics
NPI:1710934278
Name:BERONIO, JOHN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BERONIO
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:171 NORTH FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463
Mailing Address - Country:US
Mailing Address - Phone:201-447-8190
Mailing Address - Fax:201-447-4298
Practice Address - Street 1:171 NORTH FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-447-8190
Practice Address - Fax:201-447-4298
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2011-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMD2304213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57789Medicare UPIN