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40 W Kings Hwy, Mount Ephraim, NJ 08059-1303 | |
(856) 780-0779 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Podiatrist |
Location | 40 W Kings Hwy, Mount Ephraim, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1023691177 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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213E00000X | Podiatrist | (* (Not Available)) | Primary |
Provider Name | Dana M Canuso |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1164740031 PECOS PAC ID: 3577749621 Enrollment ID: I20110525000498 |
Provider Name | Jade M Gray |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1518227578 PECOS PAC ID: 5799926507 Enrollment ID: I20130720000030 |
Mailing Address | Practice Location Address |
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406 Hazelwood Ln, Marlton, NJ 08053-4706 Ph: (856) 780-0779 | 40 W Kings Hwy, Mount Ephraim, NJ 08059-1303 Ph: (856) 780-0779 |