Provider Demographics
NPI:1396932992
Name:JEFFREY A. PARKER, DPM, PC
Entity type:Organization
Organization Name:JEFFREY A. PARKER, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-856-7700
Mailing Address - Street 1:156 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1808
Mailing Address - Country:US
Mailing Address - Phone:845-856-7700
Mailing Address - Fax:845-858-9284
Practice Address - Street 1:156 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1808
Practice Address - Country:US
Practice Address - Phone:845-856-7700
Practice Address - Fax:845-858-9284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0027271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PNW301Medicare PIN