Healthcare Provider Details

I. General information

NPI: 1336200799
Provider Name (Legal Business Name): PAUL S. DEMARCO, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SHORE RD
SOMERS POINT NJ
08244-2630
US

IV. Provider business mailing address

401 SHORE RD
SOMERS POINT NJ
08244-2630
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-4894
  • Fax: 609-601-1439
Mailing address:
  • Phone: 609-927-4894
  • Fax: 609-601-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD02049
License Number StateNJ

VIII. Authorized Official

Name: DR. PAUL S DEMARCO
Title or Position: OWNER
Credential: DPM
Phone: 609-927-4894