Healthcare Provider Details

I. General information

NPI: 1528106960
Provider Name (Legal Business Name): FAMILY FOOT AND ANKLE CENTER OF SOUTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 KINGS HWY N SUITE 110
CHERRY HILL NJ
08034-1906
US

IV. Provider business mailing address

1020 KINGS HWY N SUITE 110
CHERRY HILL NJ
08034-1906
US

V. Phone/Fax

Practice location:
  • Phone: 856-667-8222
  • Fax: 856-667-9739
Mailing address:
  • Phone: 856-667-8222
  • Fax: 856-667-9739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH L DIMENNA III
Title or Position: PODIATRIST-OWNER
Credential: DPM
Phone: 856-667-8222