Provider Demographics
NPI:1811173750
Name:JACK RESSLER
Entity type:Organization
Organization Name:JACK RESSLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:RESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-955-0405
Mailing Address - Street 1:1440 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 333
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5433
Mailing Address - Country:US
Mailing Address - Phone:561-955-0405
Mailing Address - Fax:954-752-0197
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE B5
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-955-0405
Practice Address - Fax:954-752-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3870900001Medicare NSC