Provider Demographics
NPI:1780828228
Name:CAMDEN COUNTY FOOT & ANKLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:CAMDEN COUNTY FOOT & ANKLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-858-3939
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1299
Mailing Address - Country:US
Mailing Address - Phone:856-546-8989
Mailing Address - Fax:856-546-8905
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 10A
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-546-8989
Practice Address - Fax:856-546-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00145500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0232165Medicaid
NJ6354330001Medicare NSC
NJ0232165Medicaid