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NPI Code Detail

MEDICARE: JAKE ROBERT MCDERMOTT

MEDICARE: JAKE ROBERT MCDERMOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramNY

General Provider Information

NPI Number : 1013856921
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKE ROBERT MCDERMOTT
Provider Business Mailing Address
First Line : 1148 UNION ST APT 4E
Second Line :
City : BROOKLYN
State : NY
Zip : 11225-1444
Country : US
Telephone Number : 516-554-7012
Fax Number :
Provider Business Practice Location Address
First Line : 450 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2012
Country : US
Telephone Number : 718-270-2179
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2026
Last Update Date : 03/26/2026

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Directions to “ JAKE ROBERT MCDERMOTT ” Practice Location

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