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Contact Information

JAY M MICKENBERG, DPM
8094 EDWIN RAYNOR BLVD
SUITE C
PASADENA, MD21122-6834
 Phone: 410-255-0040
 Fax: 410-360-4955
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for JAY M MICKENBERG · (Male)

NPI Number 1336149962
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/26/2005
Last updated 02/21/2024 - About 2 years ago
Sole proprietor 1 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(s) Not Available
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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