Assoc. of Maple Podiatry,PA

Primary specialty

PodiatristTaxonomy code 213E00000X

License

MD00151900 Issued in NJ

Legal business name

ASSOC. OF MAPLE PODIATRY,PA

Practice address

702 W Maple Ave
Merchantville, NJ 08109-1822

Phone

(856) 665-1180

Fax

(856) 665-5537

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John A Wallace, DPM

Title

Owner

Phone

(856) 665-1180

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1972540854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 W MAPLE AVE",
            "city": "MERCHANTVILLE",
            "state": "NJ",
            "postal_code": "081091822",
            "telephone_number": "856-665-1180",
            "fax_number": "856-665-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W MAPLE AVE",
            "city": "MERCHANTVILLE",
            "state": "NJ",
            "postal_code": "081091822",
            "telephone_number": "856-665-1180",
            "fax_number": "856-665-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOC. OF MAPLE PODIATRY,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-665-1180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "MD00151900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON NJ HEALTH",
            "identifier": "60008976",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0078854000",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0037575",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Kate Adams, APN
• Amybeth Levie Berner, MA, LPC, NBCC
• Abigail Bogner, PTA
• Michelle Bruno, CF-SLP
• Busy Bee Aac LLC
• Meghan Calavano

• Podiatrist in Merchantville, NJ
• Providers in Merchantville, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; 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.