Healthcare Provider Details

I. General information

NPI: 1609863414
Provider Name (Legal Business Name): JOSH BARRY OTTENHEIMER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 PRINCETON HIGHTSTOWN RD
WEST WINDSOR NJ
08550-3127
US

IV. Provider business mailing address

206 BARCLAY BLVD
PRINCETON NJ
08540-5875
US

V. Phone/Fax

Practice location:
  • Phone: 609-799-0043
  • Fax: 609-799-0047
Mailing address:
  • Phone: 609-240-2973
  • Fax: 609-799-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD0027960
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: