Healthcare Provider Details

I. General information

NPI: 1174700496
Provider Name (Legal Business Name): JAIME ALBERTO URIBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 30
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE # 30
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8995
  • Fax:
Mailing address:
  • Phone: 718-270-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number256196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: