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Organization
CHARLES L. DIETZEK
Active
Organization
CHARLES L. DIETZEK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN BERKOWITZ (BILLING MANAGER)
(856) 309-9777
Entity
Organization
Contact information
Practice address
543 EGG HARBOR RD, SEWELL, NJ 08080-2335
(856) 256-2063
Mailing address
1000 WHITE HORSE RD, SUITE 703, VOORHEES, NJ 08043-4406
(856) 309-9777
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
—
2417720000
AMERIHEALTH
NJ
01
—
3947376
AETNA
NJ
Enumeration date
01/19/2007
Last updated
08/22/2020
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