MEDICARE: JEYCE DECLUE DPM

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
1	213ES0131X	Foot Surgery Podiatrist	N006064	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306827514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEYCE DECLUE DPM

Provider Business Mailing Address
First Line	:	15 BIRCH HILL RD
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-1903
Country	:	US
Telephone Number	:	631-338-4329
Fax Number	:

Provider Business Practice Location Address
First Line	:	3049 BRIGHTON 6TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6409
Country	:	US
Telephone Number	:	718-872-5721
Fax Number	:	718-872-5722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	11/20/2012

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