Healthcare Provider Details

I. General information

NPI: 1558549311
Provider Name (Legal Business Name): JACOB NACHUM OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BROADWAY SUITE 908
NEW YORK NY
10004-1703
US

IV. Provider business mailing address

26 BROADWAY SUITE 908
NEW YORK NY
10004-1703
US

V. Phone/Fax

Practice location:
  • Phone: 212-425-2115
  • Fax: 212-425-2636
Mailing address:
  • Phone: 212-425-2115
  • Fax: 212-425-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberTUV004313-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberTUV004314-01
License Number StateNY

VIII. Authorized Official

Name: DR. JACOB NACHUM
Title or Position: PRESIDENT
Credential: O.D.
Phone: 212-425-2115