Provider Demographics
NPI:1164481222
Name:JARBATH, JOHN ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:JARBATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3521
Mailing Address - Country:US
Mailing Address - Phone:917-378-2305
Mailing Address - Fax:516-538-0361
Practice Address - Street 1:7 SURREY LN
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3521
Practice Address - Country:US
Practice Address - Phone:917-378-2305
Practice Address - Fax:516-538-0361
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005380213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01808786Medicaid
NY01808786Medicaid
NY02500Medicare ID - Type Unspecified