Healthcare Provider Details

I. General information

NPI: 1487925004
Provider Name (Legal Business Name): BTD GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ROUTE 70 W
CHERRY HILL NJ
08002-3096
US

IV. Provider business mailing address

295 ROUTE 70 W
CHERRY HILL NJ
08002-3096
US

V. Phone/Fax

Practice location:
  • Phone: 856-216-8003
  • Fax: 856-216-8223
Mailing address:
  • Phone: 856-216-8003
  • Fax: 856-216-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License NumberC46786
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC46786
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC46786
License Number StateNJ

VIII. Authorized Official

Name: MR. BRIAN T. DI GIULIO
Title or Position: OWNER
Credential: CERTIFIED PEDORTHIST
Phone: 856-216-8003