Provider Demographics
NPI:1285248286
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:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-283-3800
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:772-283-7046
Practice Address - Street 1:3515 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5059
Practice Address - Country:US
Practice Address - Phone:772-283-3800
Practice Address - Fax:772-283-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty