Healthcare Provider Details

I. General information

NPI: 1326043431
Provider Name (Legal Business Name): ERIC S. BASKIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 BEACON AVE
MANAHAWKIN NJ
08050-2469
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-6092
  • Fax: 609-597-7458
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25M000279000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: