MEDICARE: YAKOV HAIMOF 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	25MD00325300	NJ

General Provider Information

NPI Number	:	1366821019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAKOV HAIMOF DPM

Provider Business Mailing Address
First Line	:	185 BRIDGE PLZ N
Second Line	:	SUITE 4
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5907
Country	:	US
Telephone Number	:	201-363-9844
Fax Number	:	201-363-9662

Provider Business Practice Location Address
First Line	:	185 BRIDGE PLZ N
Second Line	:	SUITE 4
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5907
Country	:	US
Telephone Number	:	201-363-9844
Fax Number	:	201-363-9662

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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Directions to “ YAKOV HAIMOF DPM” Practice Location

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