Healthcare Provider Details

I. General information

NPI: 1417026121
Provider Name (Legal Business Name): JAY ROBERT NEWMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15340 S JOG RD STE 205
DELRAY BEACH FL
33446-2170
US

IV. Provider business mailing address

15340 S JOG RD STE 205
DELRAY BEACH FL
33446-2170
US

V. Phone/Fax

Practice location:
  • Phone: 561-638-7600
  • Fax: 561-638-6787
Mailing address:
  • Phone: 561-638-7600
  • Fax: 561-638-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: