Provider Demographics
NPI:1942221270
Name:KAMENITZ, MARC B (DPM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:B
Last Name:KAMENITZ
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 1:1230 WHITEHORSE MERCERVILLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3838
Mailing Address - Country:US
Mailing Address - Phone:609-585-0500
Mailing Address - Fax:609-585-5975
Practice Address - Street 1:321 N WARREN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4794
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004363L213E00000X
NJ25MD00266800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ188545OtherAMERIGROUP
P3057131OtherOXFORD
NJ60005024OtherHORIZON NJ HEALTH
1568146OtherINDEPENDENCE BLUE CROSS
NJ8905100Medicaid
6299015OtherGHI
2263552000OtherKEYSTONE HEALTH PLAN
NJ60005024OtherHORIZON NJ HEALTH
1568146OtherINDEPENDENCE BLUE CROSS
U83538Medicare UPIN
PA0000045154Medicare NSC
NJ188545OtherAMERIGROUP
480034837Medicare ID - Type UnspecifiedRAILROAD MEDICARE