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General NPI Number Information
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NPI Number | 1144847104
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Entity Type | Organization
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Legal Business Name | JNC PODIATRY LLC
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 572 TALL OAKS TER
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City | LONGWOOD
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State | FL
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Zip | 32750-8419
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Country | US
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Telephone | 407-497-5826
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 W LAKE MARY BLVD UNIT 950848
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City | LAKE MARY
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State | FL
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Zip | 32795-7535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JORIS CLAESSENS
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Credential |
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Telephone | 407-497-5826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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