| Organization Name: | COMPREHENSIVE FOOT & ANKLE CENTER OF SOUTH JERSEY LLC |
| NPI Number: | 1215076237 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELENA KATHLEEN WELLENS (OWNER) |
| Mailing Address: | 277 White Horse Pike Suite 101 Atco |
| State: | NJ US |
| Postal Code: | 08004 |
| Phone Number: | 8567687850 |
| Fax Number: | 8567687853 |
| NPI Enumeration Date: | 02/06/2007 |
| NPI Last Update Date: | 12/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 25MD00274600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |