Provider Demographics
NPI:1770232357
Name:DEBROFF, JAKE
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:DEBROFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 17TH ST FL 20
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3805
Mailing Address - Country:US
Mailing Address - Phone:212-420-3363
Mailing Address - Fax:
Practice Address - Street 1:350 E 17TH ST FL 20
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3805
Practice Address - Country:US
Practice Address - Phone:212-420-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program