Provider Demographics
NPI:1518058783
Name:DACHER, JEFFREY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:DACHER
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 1:3901 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2150
Mailing Address - Country:US
Mailing Address - Phone:718-648-9104
Mailing Address - Fax:718-648-0895
Practice Address - Street 1:3901 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2150
Practice Address - Country:US
Practice Address - Phone:718-648-9104
Practice Address - Fax:718-648-0895
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004220-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01067596Medicaid
NY01067596Medicaid
T86772Medicare UPIN