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General NPI Number Information
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NPI Number | 1356484026
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Entity Type | Individual
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Provider Name | JEFFREY TRAUB D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 554 LARKFIELD RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-4205
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Country | US
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Telephone | 631-266-1042
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Fax | 516-385-8732
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Provider Business Mailing Address
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Address Line | 600 WILDWOOD RD
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-3410
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Country | US
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Telephone | 631-266-1042
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Fax |
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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 | N004729
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License Number State | NY
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