MEDICARE: DR. JOSH BARRY OTTENHEIMER 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	213E00000X	Podiatrist	25MD0027960	NJ

General Provider Information

NPI Number	:	1609863414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSH BARRY OTTENHEIMER D.P.M.

Provider Business Mailing Address
First Line	:	206 BARCLAY BLVD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-5875
Country	:	US
Telephone Number	:	609-240-2973
Fax Number	:	609-799-0047

Provider Business Practice Location Address
First Line	:	263 PRINCETON HIGHTSTOWN RD
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-3127
Country	:	US
Telephone Number	:	609-799-0043
Fax Number	:	609-799-0047

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/12/2010

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