Provider Demographics
NPI:1649457169
Name:STUART W HONICK DPM PT LLC
Entity type:Organization
Organization Name:STUART W HONICK DPM PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:W
Authorized Official - Last Name:HONICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-704-9001
Mailing Address - Street 1:392 N. WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1866
Mailing Address - Country:US
Mailing Address - Phone:609-704-9001
Mailing Address - Fax:609-704-8316
Practice Address - Street 1:392 N. WHITE HORSE PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1866
Practice Address - Country:US
Practice Address - Phone:609-704-9001
Practice Address - Fax:609-704-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6471005Medicaid
NJ6269080001Medicare NSC
NJU56575Medicare UPIN
NJ6471005Medicaid