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General NPI Number Information
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NPI Number | 1588624902
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Entity Type | Individual
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Provider Name | JEROME E. REEVES DPM
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20507 HILLSIDE AVE SUITE 15
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City | HOLLIS
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State | NY
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Zip | 11423-2220
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Country | US
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Telephone | 718-479-5747
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Fax | 718-479-5745
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Provider Business Mailing Address
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Address Line | 8451 BEVERLY RD 2T
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City | JAMAICA
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State | NY
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Zip | 11415-2123
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Country | US
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Telephone | 718-441-6271
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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 | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005132
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License Number State | NY
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