1356370332 NPI number — COMAPSSIONATE PODIATRY

Table of content: MS. BERYL ELAINE MINKLE LICSW (NPI 1386635472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356370332 NPI number — COMAPSSIONATE PODIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMAPSSIONATE PODIATRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1356370332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 COLONY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-8785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-308-0963
Provider Business Mailing Address Fax Number:
856-854-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 HADDON AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLINGSWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08108-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-833-1479
Provider Business Practice Location Address Fax Number:
856-854-7969
Provider Enumeration Date:
07/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERNESTO
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-308-0963

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  25MD00207600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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