Healthcare Provider Details

I. General information

NPI: 1134427784
Provider Name (Legal Business Name): NORTHFIELD PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MAIN ST SUITE 350
WEST ORANGE NJ
07052-5341
US

IV. Provider business mailing address

PO BOX 73
WEST ORANGE NJ
07052-0073
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA WILLIAMS BENNETT
Title or Position: PRESIDENT
Credential: DPM
Phone: 732-321-1100