Healthcare Provider Details

I. General information

NPI: 1871607218
Provider Name (Legal Business Name): STANLEY S BODZIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BERLIN RD SUITE 5000
CHERRY HILL NJ
08034-3574
US

IV. Provider business mailing address

52 BERLIN RD SUITE 5000
CHERRY HILL NJ
08034-3574
US

V. Phone/Fax

Practice location:
  • Phone: 856-795-1003
  • Fax: 856-795-5994
Mailing address:
  • Phone: 856-795-1003
  • Fax: 856-795-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001895L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD103700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: