Provider Demographics
NPI:1194839092
Name:SEESE, JIMMY (DPM)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:SEESE
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 1:2175 LEMOINE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6001
Mailing Address - Country:US
Mailing Address - Phone:201-944-4477
Mailing Address - Fax:201-944-9998
Practice Address - Street 1:2175 LEMOINE AVE STE 302
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6001
Practice Address - Country:US
Practice Address - Phone:201-944-4477
Practice Address - Fax:201-944-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD2346213ES0103X
NYN005549-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ883781Medicare PIN
NJU62252Medicare UPIN
NY04179Medicare PIN