Provider Demographics
NPI:1881808418
Name:JESPERSEN, DAVID LANING (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANING
Last Name:JESPERSEN
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 1:10 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-4293
Mailing Address - Country:US
Mailing Address - Phone:856-293-1880
Mailing Address - Fax:856-293-1889
Practice Address - Street 1:10 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4293
Practice Address - Country:US
Practice Address - Phone:856-293-1880
Practice Address - Fax:856-293-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00256400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7040196OtherAETNA PROVIDER #
NJ8270902Medicaid
NJ201840202OtherTAX ID
NJ201840202OtherTAX ID
NJ037385Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NJ5310230001Medicare NSC
NJP00188130Medicare PIN