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General NPI Number Information
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NPI Number | 1306905658
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Entity Type | Organization
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Legal Business Name | CHARLES L DIETZEK, DO, FACOS, PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 1000 WHITE HORSE RD SUITE 703
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-309-9777
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Fax | 856-309-9774
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Provider Business Mailing Address
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Address Line | 1000 WHITE HORSE RD SUITE 703
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City | VOORHEES
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State | NJ
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Zip | 08043-4406
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Country | US
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Telephone | 856-309-9777
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Fax | 856-309-9774
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SUSAN BERKOWITZ
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Credential |
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Telephone | 856-309-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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