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NPI Code Detail

MEDICARE: JIMMY VAN D.P.M.

MEDICARE: JIMMY VAN D.P.M.
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
1207X00000XOrthopaedic Surgery PhysicianN006604NY

General Provider Information

NPI Number : 1396032355
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY VAN D.P.M.
Provider Business Mailing Address
First Line : 443 LINDEN BLVD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2821
Country : US
Telephone Number : 718-282-6333
Fax Number : 718-765-0545
Provider Business Practice Location Address
First Line : 443 LINDEN BLVD
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2821
Country : US
Telephone Number : 718-282-6333
Fax Number : 718-765-0545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2011
Last Update Date : 03/13/2015

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