Provider Demographics
NPI:1790787398
Name:SANTOMAURO, JOSEPH M JR (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:SANTOMAURO
Suffix:JR
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 1:704 E MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3070
Mailing Address - Country:US
Mailing Address - Phone:856-866-8998
Mailing Address - Fax:856-866-9746
Practice Address - Street 1:400 N CHURCH ST STE 125
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1700
Practice Address - Country:US
Practice Address - Phone:856-866-8998
Practice Address - Fax:856-866-9746
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005661213E00000X
NJ25MD00287500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2848663000OtherAMERIHEALTH
P3739643OtherOXFORD
7186646OtherAETNA PPO
1541273OtherAETNA HMO
105402NCTMedicare PIN
NJV05373Medicare UPIN