Provider Demographics
NPI:1154320539
Name:RESSLER, JACK EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:EDWARD
Last Name:RESSLER
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1440 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 333
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:561-955-0405
Mailing Address - Fax:954-752-0197
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE B5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-955-0405
Practice Address - Fax:954-752-0197
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2016-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0001620213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87923Medicare PIN