Provider Demographics
NPI:1023096997
Name:WITKIN, MORDECAI M (DPM)
Entity type:Individual
Prefix:DR
First Name:MORDECAI
Middle Name:M
Last Name:WITKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CONFORTI AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2828
Mailing Address - Country:US
Mailing Address - Phone:973-325-9228
Mailing Address - Fax:
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-696-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00197600213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine