Provider Demographics
NPI:1326046608
Name:EPSTEIN, JILL C (DPM)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 SUNGLO DR
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8673
Mailing Address - Country:US
Mailing Address - Phone:610-349-6703
Mailing Address - Fax:610-691-0642
Practice Address - Street 1:35 E ELIZABETH AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-349-6703
Practice Address - Fax:610-691-0642
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004817L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019717590001Medicaid
PA0019717590001Medicaid
U96185Medicare UPIN