1265478333 NPI number — BRUCE ELIAS KAMEN DPM

Table of content: BRUCE ELIAS KAMEN DPM (NPI 1265478333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265478333 NPI number — BRUCE ELIAS KAMEN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMEN
Provider First Name:
BRUCE
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265478333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1762 GARWOOD DRIVE
Provider Second Line Business Mailing Address:
BRUCE E KAMEN DPM
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-904-3393
Provider Business Mailing Address Fax Number:
856-616-1352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 CHAMPLAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-904-3393
Provider Business Practice Location Address Fax Number:
856-616-1352
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  25MD00139800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: E10000130 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: SC002449L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009510540003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480003154 . This is a "RR MC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000823017 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024974 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 480003154 . This is a "RR MC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5588201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 448333 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 480003154 . This is a "RR MC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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