Healthcare Provider Details

I. General information

NPI: 1356370332
Provider Name (Legal Business Name): COMAPSSIONATE PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 HADDON AVE STE C
COLLINGSWOOD NJ
08108-1449
US

IV. Provider business mailing address

172 COLONY LN
MANALAPAN NJ
07726-8785
US

V. Phone/Fax

Practice location:
  • Phone: 856-833-1479
  • Fax: 856-854-7969
Mailing address:
  • Phone: 732-308-0963
  • Fax: 856-854-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00207600
License Number StateNJ

VIII. Authorized Official

Name: DR. RALPH JOSEPH ERNESTO
Title or Position: OWNER
Credential: DPM
Phone: 732-308-0963