Provider Demographics
NPI:1295894558
Name:AFFILIATED PODIATRISTS OF SOUTH JERSEY LTD
Entity type:Organization
Organization Name:AFFILIATED PODIATRISTS OF SOUTH JERSEY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODMEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:AJDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-691-2152
Mailing Address - Street 1:150 S MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7828
Mailing Address - Country:US
Mailing Address - Phone:856-691-2152
Mailing Address - Fax:856-696-3474
Practice Address - Street 1:150 S MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7828
Practice Address - Country:US
Practice Address - Phone:856-691-2152
Practice Address - Fax:856-696-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2283213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty