Provider Demographics
NPI:1649287392
Name:JEZIERSKI, JOEL (DPM)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:JEZIERSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WEST 57TH STREET
Mailing Address - Street 2:STE 1201
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4612
Mailing Address - Country:US
Mailing Address - Phone:716-456-8027
Mailing Address - Fax:212-755-3676
Practice Address - Street 1:57 WEST 57TH STREET
Practice Address - Street 2:STE 1201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4612
Practice Address - Country:US
Practice Address - Phone:716-456-8027
Practice Address - Fax:212-755-3676
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005029213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP6042OtherBLUE CROSS BLUE SHIELD
NY01493172Medicaid
NY6002316OtherGHI
NYP60421Medicare ID - Type Unspecified
P60422Medicare ID - Type Unspecified
NY01493172Medicaid