Healthcare Provider Details

I. General information

NPI: 1104275940
Provider Name (Legal Business Name): ANTHONY JABRA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 E 124TH ST
NEW YORK NY
10035-1815
US

IV. Provider business mailing address

53 E 124TH ST
NEW YORK NY
10035-1815
US

V. Phone/Fax

Practice location:
  • Phone: 212-410-8100
  • Fax:
Mailing address:
  • Phone: 212-410-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: