Provider Demographics
NPI:1912945353
Name:FAMILY FOOT AND ANKLE CENTER OF SOUTH JERSEY
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CENTER OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIMENNA III
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-667-8222
Mailing Address - Street 1:1020 KINGS HWY N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1906
Mailing Address - Country:US
Mailing Address - Phone:856-667-8222
Mailing Address - Fax:856-667-9739
Practice Address - Street 1:1020 KINGS HWY N
Practice Address - Street 2:SUITE 110
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-667-8222
Practice Address - Fax:856-667-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ795145TTZMedicare ID - Type Unspecified