Provider Demographics
NPI:1609892389
Name:COURBIS, JEANNE MARY (DPM)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARY
Last Name:COURBIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 JERICHO TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2852
Mailing Address - Country:US
Mailing Address - Phone:631-864-7380
Mailing Address - Fax:631-864-7381
Practice Address - Street 1:6143 JERICHO TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2852
Practice Address - Country:US
Practice Address - Phone:631-864-7380
Practice Address - Fax:631-864-7381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006166213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02832740Medicaid
NY07800GMedicare PIN
NY02832740Medicaid
NYPDWF01Medicare PIN
NYV09981Medicare UPIN
NY07800Medicare PIN