Provider Demographics
NPI:1528073822
Name:JABBOUR, DANY YOUSSEF (DPM)
Entity type:Individual
Prefix:DR
First Name:DANY
Middle Name:YOUSSEF
Last Name:JABBOUR
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 1:91 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1146
Mailing Address - Country:US
Mailing Address - Phone:845-876-8637
Mailing Address - Fax:845-876-0218
Practice Address - Street 1:91 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1146
Practice Address - Country:US
Practice Address - Phone:845-876-8637
Practice Address - Fax:845-876-0218
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006140213E00000X, 213EP1101X
NYN006140-01213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93-2014012OtherTAX ID
NY02911622Medicaid
CJ2100OtherRAILROAD MEDICARE GROUP PIN/IDENTIFIER
GRP408871001OtherBLUE SHIELD NORTHEASTERN NY GROUP PIN/IDENTIFIER
000932161004OtherBS NORTHEASTERN NY PIN/IDENTIFIER
PM4111OtherBLUE CROSS PRUE SHIELD PIN/IDENTIFIER
30061OtherTAX ID LAST 5 DIGITS
30061OtherTAX ID LAST 5 DIGITS
PK755PAE21Medicare PIN
480003167Medicare PIN
0488940001Medicare Oscar/Certification
1235164997OtherGROUP NPI: L S GERBER DPM & C BROMLEY DPM PC
PAWE21Medicare PIN