Healthcare Provider Details

I. General information

NPI: 1497890008
Provider Name (Legal Business Name): MOORESTOWN FOOT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 CHURCH RD
MOUNT LAUREL NJ
08054-2210
US

IV. Provider business mailing address

4514 CHURCH RD
MOUNT LAUREL NJ
08054-2210
US

V. Phone/Fax

Practice location:
  • Phone: 856-220-6526
  • Fax: 856-235-3105
Mailing address:
  • Phone: 856-220-6526
  • Fax: 856-235-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RONALD BARBELLA
Title or Position: OWNER
Credential: DPM
Phone: 856-220-6526