Healthcare Provider Details

I. General information

NPI: 1639443492
Provider Name (Legal Business Name): JEFFREY MICHAEL BELANCIO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 STATE ST STE 5
ELMER NJ
08318-2164
US

IV. Provider business mailing address

134 E TAYLOR AVE APT 1
WILDWOOD NJ
08260-4533
US

V. Phone/Fax

Practice location:
  • Phone: 856-839-0579
  • Fax: 856-839-0413
Mailing address:
  • Phone: 856-839-0579
  • Fax: 856-839-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00312000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: