MEDICARE: DR. JEROME E. REEVES DPM

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	213ES0131X	Foot Surgery Podiatrist	N005132	NY

General Provider Information

NPI Number	:	1588624902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME E. REEVES DPM

Provider Business Mailing Address
First Line	:	8451 BEVERLY RD
Second Line	:	2T
City	:	JAMAICA
State	:	NY
Zip	:	11415-2123
Country	:	US
Telephone Number	:	718-441-6271
Fax Number	:

Provider Business Practice Location Address
First Line	:	20507 HILLSIDE AVE
Second Line	:	SUITE 15
City	:	HOLLIS
State	:	NY
Zip	:	11423-2220
Country	:	US
Telephone Number	:	718-479-5747
Fax Number	:	718-479-5745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	07/08/2007

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