National Provider Identifier Database

JAY M MICKENBERG, DPM – NPI #1336149962
Podiatrist

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Contact Information

JAY M MICKENBERG, DPM
8094 EDWIN RAYNOR BLVD
SUITE C
PASADENA, MD  21122-6834
Phone: 410-255-0040
Fax: 410-360-4955
Website:
Specialty Taxonomy Code
* Podiatrist 213E00000X

* Indicates primary specialty

NPI Profile & details for JAY M MICKENBERG

NPI Number 1336149962
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/26/2005
Last updated 02/21/2024 - About 2 years ago
Sole proprietor1 Yes
Identifiers
  • MD License #: 1053
  • MD Medicaid: 062308301
  • Other: 217484 ALLIANCE
  • Other: B765 001 BC/BS FEDERAL
  • Other: 521617469 CIGNA HEALTHCARE OPEN ACC
  • Other: 1338463 CIGNA PPO/HMO
  • Other: 521617469 COVENTRY
  • Other: 521617469 EHP
  • Other: 521617469 EMPLOYER HEALTH INSURANCE
  • Other: 521617469 FIDELITY
  • Other: 521617469 FIRST HEALTH
  • Other: 521617469 MAMSI
  • Other: 217484 MDIPA/OPTIMUM CHOICE
  • Other: 480012800 RAILROAD MEDICARE
  • Other: 521617469 TRICARE
  • Other: 521617469 UNITED HEALTHCARE
  • MD Other: T276 BC/BS OF MD
  • MD Other: B765 BLUE CHOICE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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