Provider Demographics
NPI:1609058825
Name:BLOCK & JACOBS PA
Entity Type:Organization
Organization Name:BLOCK & JACOBS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-454-5221
Mailing Address - Street 1:1001 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2400
Mailing Address - Country:US
Mailing Address - Phone:954-454-5221
Mailing Address - Fax:
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2400
Practice Address - Country:US
Practice Address - Phone:954-454-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4866110001Medicare NSC