MEDICARE: MOORESTOWN FOOT SPECIALISTS, LLC

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	213E00000X	Podiatrist
2	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2367438	OTHER	NJ	CIGNA
3	0290123000	OTHER	NJ	AMERIHEALTH

General Provider Information

NPI Number	:	1497890008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORESTOWN FOOT SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	4514 CHURCH RD
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2210
Country	:	US
Telephone Number	:	856-220-6526
Fax Number	:	856-235-3105

Provider Business Practice Location Address
First Line	:	4514 CHURCH RD
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2210
Country	:	US
Telephone Number	:	856-220-6526
Fax Number	:	856-235-3105

Authorized Official
Title or Position	:	OWNER
Name	:	RONALD BARBELLA
Credential	:	DPM
Telephone Number	:	856-220-6526

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/21/2022

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