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Organization
CHARLES L DIETZEK, DO, FACOS, PC
Active
Organization
CHARLES L DIETZEK, DO, FACOS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN BERKOWITZ (BILLING MANAGER)
(856) 309-9777
Entity
Organization
Contact information
Practice address
1000 WHITE HORSE RD, SUITE 703, VOORHEES, NJ 08043-4406
(856) 309-9777
(856) 309-9774
Mailing address
1000 WHITE HORSE RD, SUITE 703, VOORHEES, NJ 08043-4406
(856) 309-9777
(856) 309-9774
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071641
—
NJ
01
—
3947376
AETNA
—
01
—
60017604
HORIZON
—
Enumeration date
12/06/2006
Last updated
02/05/2008
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