Healthcare Provider Details

I. General information

NPI: 1982225660
Provider Name (Legal Business Name): BRANDON LEE SCHLAKMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS WAY E STE D6
SEWELL NJ
08080-2238
US

IV. Provider business mailing address

100 KINGS WAY E STE D6
SEWELL NJ
08080-2238
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-6082
  • Fax: 856-582-6083
Mailing address:
  • Phone: 856-582-6082
  • Fax: 856-582-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00373800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: