MEDICARE: JAY M HARMELIN

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	25MD00138500	NJ

General Provider Information

NPI Number	:	1871770446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY M HARMELIN

Provider Business Mailing Address
First Line	:	23 CRESTVIEW DR
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-1611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 CRESTVIEW DR
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-1611
Country	:	US
Telephone Number	:	609-927-1105
Fax Number	:	609-926-2038

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANET M HARMELIN
Credential	:
Telephone Number	:	609-233-8961

Provider Enumeration Date	:	01/26/2008
Last Update Date	:	01/26/2008

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