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General NPI Number Information
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NPI Number | 1881808418
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Entity Type | Individual
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Provider Name | DAVID LANING JESPERSEN DPM
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 10 E MAIN ST STE B
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City | MILLVILLE
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State | NJ
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Zip | 08332-4293
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Country | US
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Telephone | 856-293-1880
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Fax | 856-293-1889
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Provider Business Mailing Address
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Address Line | 10 E MAIN ST STE B
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City | MILLVILLE
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State | NJ
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Zip | 08332-4293
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Country | US
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Telephone | 856-293-1880
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Fax | 856-293-1889
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 25MD00256400
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License Number State | NJ
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