Healthcare Provider Details

I. General information

NPI: 1225498355
Provider Name (Legal Business Name): SOUTH JERSEY FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 STATE ST STE 5
ELMER NJ
08318-2164
US

IV. Provider business mailing address

525 STATE ST STE 5
ELMER NJ
08318-2164
US

V. Phone/Fax

Practice location:
  • Phone: 856-839-0579
  • Fax: 877-246-2949
Mailing address:
  • Phone: 609-352-4477
  • Fax: 877-246-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00312000
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY MICHAEL BELANCIO
Title or Position: PODIATRIST
Credential: DPM
Phone: 856-839-0579