=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407151046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES F. BIRK, DPM, FACFAS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2011
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 E MECHANIC ST
-----------------------------------------------------
City | CAPE MAY COURT HOUSE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08210-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-465-1644
-----------------------------------------------------
Fax | 609-465-6180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 E MECHANIC ST
-----------------------------------------------------
City | CAPE MAY COURT HOUSE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08210-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-465-1644
-----------------------------------------------------
Fax | 609-465-6180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST-OWNER
-----------------------------------------------------
Name | DR. CHARLES F BIRK
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 609-465-1644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------