Provider Demographics
NPI:1588667570
Name:ROOT, SHARON MILLER (DPM)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:MILLER
Last Name:ROOT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:151 ROUTE 10
Mailing Address - Street 2:STE 102
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1452
Mailing Address - Country:US
Mailing Address - Phone:973-252-8787
Mailing Address - Fax:973-252-9086
Practice Address - Street 1:151 ROUTE 10
Practice Address - Street 2:STE 102
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1452
Practice Address - Country:US
Practice Address - Phone:973-252-8787
Practice Address - Fax:973-252-9086
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMD002203213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6013601Medicaid
NJ6013601Medicaid
1588667570Medicare NSC
U34293Medicare UPIN