Provider Demographics
NPI:1396032355
Name:VAN, JIMMY (DPM)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:VAN
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 1:443 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2821
Mailing Address - Country:US
Mailing Address - Phone:718-282-6333
Mailing Address - Fax:718-765-0545
Practice Address - Street 1:443 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2821
Practice Address - Country:US
Practice Address - Phone:718-282-6333
Practice Address - Fax:718-765-0545
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006604207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery