Charles L Dietzek, DO, Facos, PC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

CHARLES L DIETZEK, DO, FACOS, PC

Practice address

1000 White Horse Rd
Suite 703
Voorhees, NJ 08043-4406

Phone

(856) 309-9777

Fax

(856) 309-9774

NPI assigned

Dec 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Susan Berkowitz

Title

Billing Manager

Phone

(856) 309-9777

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Tax ID family

Charles L Dietzek3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Charles L. Dietzek

  • Vascular Surgery Physician
  • Sewell, NJ
  • NPI 1861545188
  NPD tax ID
• Kennedy Wound Care Center

  • Clinic/Center
  • Moorestown, NJ
  • NPI 1760537930
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles L Dietzek, D.O.

  • Vascular Surgery Physician
  • Voorhees, NJ
  • NPI 1639283344
  Medicare reassignment Care Compare group NPD
• Elias Fakhoury, DO

  • Vascular Surgery Physician
  • Voorhees, NJ
  • NPI 1922448539
  Medicare reassignment Care Compare group NPD
• Catherine Ann Barone, D.O.

  • Family Medicine Physician
  • Mount Laurel, NJ
  • NPI 1568676989
  NPD (past)
• Alissa Brotman-O'Neill, D.O.

  • Vascular Surgery Physician
  • Stratford, NJ
  • NPI 1649438540
  NPD (past)
• Diana Lorraine Saddel, D.O.

  • Family Medicine Physician
  • Sewell, NJ
  • NPI 1831270610
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1306905658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 WHITE HORSE RD",
            "address_2": "SUITE 703",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434406",
            "telephone_number": "856-309-9777",
            "fax_number": "856-309-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WHITE HORSE RD",
            "address_2": "SUITE 703",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434406",
            "telephone_number": "856-309-9777",
            "fax_number": "856-309-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES L DIETZEK, DO, FACOS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "BERKOWITZ",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "856-309-9777",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3947376",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071641",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON",
            "identifier": "60017604",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Champion
• Tammy Chan, NP-C
• Sweta Chandela, MD
• Janay Chandler
• Leona Chang, DO
• Danielle Chase, PHD
• David E Chasen, MD
• Colleen Chatman, PA-C
• Tusharsindhu Chhatrasinh Chauhan, MD
• Arun Chawla, M.D.

• Vascular Surgery Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Vascular Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.