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General NPI Number Information
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NPI Number | 1154320539
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Entity Type | Individual
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Provider Name | JACK EDWARD RESSLER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 5130 LINTON BLVD SUITE B5
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6596
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Country | US
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Telephone | 561-955-0405
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Fax | 954-752-0197
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Provider Business Mailing Address
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Address Line | 1440 CORAL RIDGE DR SUITE 333
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-5433
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Country | US
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Telephone | 561-955-0405
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Fax | 954-752-0197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0001620
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License Number State | FL
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