Charles L. Dietzek

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

CHARLES L. DIETZEK

Practice address

543 Egg Harbor Rd
Sewell, NJ 08080-2335

Phone

(856) 256-2063

NPI assigned

Jan 19, 2007

Last updated

Aug 22, 2020By the provider in NPPES

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

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, DO, Facos, PC

  • Vascular Surgery Physician
  • Voorhees, NJ
  • NPI 1306905658
  NPD tax ID
• Kennedy Wound Care Center

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

Practitioners 1

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
  NPD (past)

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861545188",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 EGG HARBOR RD",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802335",
            "telephone_number": "856-256-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES L. DIETZEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2417720000",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071641",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3947376",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Howard B Cetel, DDS
• CGS Family Partnership Inc.
• CGS Family Partnership Inc.
• Lilian Chan
• Chia-Yu Chao, MD
• Diane Marie Cheli, RPH
• Peter J Chen, MD
• Jessica Carol Cherry, D.O.
• Chia Yu Chao
• Anthony Thomas Chianese, DO

• Vascular Surgery Physician in Sewell, NJ
• Providers in Sewell, 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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.