Healthcare Provider Details

I. General information

NPI: 1467716092
Provider Name (Legal Business Name): RODMEHR AJDARI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MAIN RD
VINELAND NJ
08360-7828
US

IV. Provider business mailing address

150 S MAIN RD
VINELAND NJ
08360-7828
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-2152
  • Fax:
Mailing address:
  • Phone: 856-691-2152
  • Fax: 856-696-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC006354
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006354
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00327800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: