Healthcare Provider Details

I. General information

NPI: 1629111521
Provider Name (Legal Business Name): JASON MATTHEW LACHER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-8132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN006012
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00283700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: