Provider Demographics
NPI:1326299744
Name:AYOUB, JOANNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:AYOUB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BROADWAY
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9355
Mailing Address - Country:US
Mailing Address - Phone:212-810-9844
Mailing Address - Fax:929-207-3133
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:SUITE 1102
Practice Address - City:NEW YORL
Practice Address - State:NY
Practice Address - Zip Code:10018-9355
Practice Address - Country:US
Practice Address - Phone:212-810-9844
Practice Address - Fax:929-207-3133
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006456213E00000X
NYAN006456-01213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03454088Medicaid
NYA400066713Medicare PIN