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General NPI Number Information
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NPI Number | 1134427784
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Entity Type | Organization
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Legal Business Name | NORTHFIELD PODIATRY PC
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 59 MAIN ST SUITE 350
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City | WEST ORANGE
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State | NJ
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Zip | 07052-5341
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Country | US
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Telephone | 973-243-2666
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 73
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City | WEST ORANGE
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State | NJ
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Zip | 07052-0073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA WILLIAMS BENNETT
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Credential | DPM
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Telephone | 732-321-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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