Provider Demographics
NPI:1558549311
Name:JACOB NACHUM OD PC
Entity Type:Organization
Organization Name:JACOB NACHUM OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-425-2115
Mailing Address - Street 1:26 BROADWAY
Mailing Address - Street 2:SUITE 908
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1703
Mailing Address - Country:US
Mailing Address - Phone:212-425-2115
Mailing Address - Fax:212-425-2636
Practice Address - Street 1:26 BROADWAY
Practice Address - Street 2:SUITE 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1703
Practice Address - Country:US
Practice Address - Phone:212-425-2115
Practice Address - Fax:212-425-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004313-01332B00000X
NYTUV004314-01332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4355570001Medicare NSC