MEDICARE: JACOB NACHUM, OD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0120X	Cornea and External Diseases Specialist Physician
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124107685	OTHER	NY	OPTOMETRY

General Provider Information

NPI Number	:	1356119747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB NACHUM, OD, PC

Provider Business Mailing Address
First Line	:	26 BROADWAY STE 908
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-1837
Country	:	US
Telephone Number	:	121-242-5263
Fax Number	:	212-425-2636

Provider Business Practice Location Address
First Line	:	26 BROADWAY STE 908
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-1837
Country	:	US
Telephone Number	:	121-242-5263
Fax Number	:	212-425-2636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACOB NACHUM
Credential	:	OD
Telephone Number	:	917-861-8878

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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