NPIMap

Organization Active NPI

Family Foot and Ankle Center of South Jersey

  • Foot & Ankle Surgery Podiatrist
  • Cherry Hill, NJ
National Provider Identifier
1528106960
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
FAMILY FOOT AND ANKLE CENTER OF SOUTH JERSEY
Practice address
1020 Kings Hwy N
Suite 110
Cherry Hill, NJ 08034-1906
Phone
(856) 667-8222
Fax
(856) 667-9739
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Authorized official

Name
Dr. Joseph L Dimenna III, DPM
Title
Podiatrist-Owner
Phone
(856) 667-8222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X Primary

Addresses

Primary practice location

1020 Kings Hwy N
Suite 110
Cherry Hill, NJ 08034-1906

Mailing address

1020 Kings Hwy N
Suite 110
Cherry Hill, NJ 08034-1906
Phone (856) 667-8222

Other identifiers 4

IdentifierTypeStateIssuer
6695302MedicaidNJ
0334492000OtherNJAMERIHEALTH HMO GROUP
DC8897OtherNJRAILROAD MEDICARE GROUP
3713678OtherNJAETNA GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050210000210 NJ Part B Supplier - Clinic/Group Practice 1355392028 Receives reassigned benefits from 2 practitioners
Practice locations: Cherry Hill, NJ; Marlton, NJ; Voorhees, NJ
O20100930069727 NJ DME Supplier - Physician - Podiatry 1355392028 Practice locations: Cherry Hill, NJ

National Provider Directory

National Provider Directory
Tax ID family
Family Foot and Ankle Center of South Jersey2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

496 Kings Hwy N
Ste 210
Cherry Hill, NJ 08034
Phone (856) 667-8222

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1528106960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 KINGS HWY N",
            "address_2": "SUITE 110",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080341906",
            "telephone_number": "856-667-8222",
            "fax_number": "856-667-9739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 KINGS HWY N",
            "address_2": "SUITE 110",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080341906",
            "telephone_number": "856-667-8222",
            "fax_number": "856-667-9739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FOOT AND ANKLE CENTER OF SOUTH JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "DIMENNA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PODIATRIST-OWNER",
        "authorized_official_telephone_number": "856-667-8222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6695302",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO GROUP",
            "identifier": "0334492000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "DC8897",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP NUMBER",
            "identifier": "3713678",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.