Healthcare Provider Details

I. General information

NPI: 1043442593
Provider Name (Legal Business Name): JOAN M. JERRIDO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN MARIE CARVER DPM

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PLAZA DR
SEWELL NJ
08080-9207
US

IV. Provider business mailing address

1 FEDERAL ST STE SW200
CAMDEN NJ
08103-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-270-4030
  • Fax: 856-270-4044
Mailing address:
  • Phone: 856-356-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00300100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: