Healthcare Provider Details

I. General information

NPI: 1528073822
Provider Name (Legal Business Name): DANY YOUSSEF JABBOUR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MONTGOMERY ST
RHINEBECK NY
12572-1146
US

IV. Provider business mailing address

91 MONTGOMERY ST
RHINEBECK NY
12572-1146
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-8637
  • Fax: 845-876-0218
Mailing address:
  • Phone: 845-876-8637
  • Fax: 845-876-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006140
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number006140
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006140-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: