=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386706877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C A MARTINA PODIATRY ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 03/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 10TH AVE
-----------------------------------------------------
City | HADDON HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08035-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-546-6459
-----------------------------------------------------
Fax | 856-546-7636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 10TH AVE
-----------------------------------------------------
City | HADDON HEIGHTS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08035-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-546-6459
-----------------------------------------------------
Fax | 856-546-7636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARMEN A MARTINA
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 856-546-6459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 25MD00092800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------