MEDICARE: DR. MORDECAI M. WITKIN D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	25MD00197600	NJ

General Provider Information

NPI Number	:	1023096997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORDECAI M. WITKIN D.P.M.

Provider Business Mailing Address
First Line	:	72 CONFORTI AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2828
Country	:	US
Telephone Number	:	973-325-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 VALLEY RD
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3534
Country	:	US
Telephone Number	:	973-696-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	12/14/2009

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