Healthcare Provider Details

I. General information

NPI: 1194792721
Provider Name (Legal Business Name): MINH P. CAO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 BERLIN CROSS KEYS RD SUITE 100
SICKLERVILLE NJ
08081-9550
US

IV. Provider business mailing address

571 BERLIN CROSS KEYS RD SUITE 100
SICKLERVILLE NJ
08081-9550
US

V. Phone/Fax

Practice location:
  • Phone: 856-875-9553
  • Fax: 856-875-9443
Mailing address:
  • Phone: 856-875-9553
  • Fax: 856-875-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00276000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: