Provider Demographics
NPI:1255355335
Name:BIRK, CHARLES F (DPM)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:BIRK
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 1:29 E MECHANIC ST
Mailing Address - Street 2:PO BOX 538
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2219
Mailing Address - Country:US
Mailing Address - Phone:609-465-1644
Mailing Address - Fax:609-465-6180
Practice Address - Street 1:29 E MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2219
Practice Address - Country:US
Practice Address - Phone:609-465-1644
Practice Address - Fax:609-465-6180
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01829213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1084305Medicaid
NJ536491Medicare PIN
T45706Medicare UPIN