Provider Demographics
NPI:1851339659
Name:WARKALA, ROBERT J (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WARKALA
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 1:100 KINGS WAY E
Mailing Address - Street 2:SUITE D6
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:856-582-6082
Mailing Address - Fax:856-582-6083
Practice Address - Street 1:100 KINGS WAY E
Practice Address - Street 2:SUITE D6
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-582-6082
Practice Address - Fax:856-582-6083
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD-01752213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ519022Medicare PIN