Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jay Marc Mickenberg, DPM

Individual provider Podiatrist · NPI 1336149962

Dr. Jay Marc Mickenberg, DPM is a Podiatry in Pasadena, Maryland. Graduated from Temple University School of Podiatric Medicine in 1989, 37 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Maryland.

Years since qualifying
37
Trained at
Temple University School of Podiatric Medicine
Licensed in
MD
In the registry since
2005
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

8094 Edwin Raynor Blvd Ste C
Pasadena, MD 21122-6834
Phone: (410) 255-0040
Fax: (410) 360-4955
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence 1053 (MD)

Record details

NPI number1336149962
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorYes
NPI enumeratedJuly 26, 2005
Last updated in NPPESFebruary 21, 2024
Certification dateFebruary 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolTEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
Graduated 1989 (37 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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