Healthcare Provider Details

I. General information

NPI: 1124556865
Provider Name (Legal Business Name): SPRUHA MAGODIA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 MAIN ST STE 202
LAWRENCE TOWNSHIP NJ
08648-1086
US

IV. Provider business mailing address

33 BRIDGEWATER CT
JACKSON NJ
08527-4030
US

V. Phone/Fax

Practice location:
  • Phone: 609-512-1126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006863
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00362300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: