Provider Demographics
NPI:1588624902
Name:REEVES, JEROME E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:E
Last Name:REEVES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8451 BEVERLY RD
Mailing Address - Street 2:2T
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2123
Mailing Address - Country:US
Mailing Address - Phone:718-441-6271
Mailing Address - Fax:
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2220
Practice Address - Country:US
Practice Address - Phone:718-479-5747
Practice Address - Fax:718-479-5745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005132213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU50226Medicare UPIN