Provider Demographics
NPI:1477173524
Name:TEIBEL, JASCHA OSCAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASCHA
Middle Name:OSCAR
Last Name:TEIBEL
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 1:300 ALEXANDER ST APT 212
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1955
Mailing Address - Country:US
Mailing Address - Phone:585-703-6774
Mailing Address - Fax:
Practice Address - Street 1:85 S UNION ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:24559
Practice Address - Country:US
Practice Address - Phone:585-721-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY007336213E00000X
IL135.001087213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery