Healthcare Provider Details

I. General information

NPI: 1033368022
Provider Name (Legal Business Name): JACOB MANN REINKRAUT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RTE 17
RIDGEWOOD NJ
07450-2010
US

IV. Provider business mailing address

400 ROUTE 17
RIDGEWOOD NJ
07450-2010
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2288
  • Fax:
Mailing address:
  • Phone: 201-445-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00298000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: