Provider Demographics
NPI:1841032836
Name:DR JESSICA TAUB PODIATRY DPM LLC
Entity type:Organization
Organization Name:DR JESSICA TAUB PODIATRY DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AOUTORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:216-402-3827
Mailing Address - Street 1:3515 SE WILLOUGHBY BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5059
Mailing Address - Country:US
Mailing Address - Phone:772-283-3800
Mailing Address - Fax:
Practice Address - Street 1:1331 SE PORT ST LUCIE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5331
Practice Address - Country:US
Practice Address - Phone:772-283-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty