Provider Demographics
NPI:1992709455
Name:DE MEO, JAMES R (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:DE MEO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 S BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4006
Mailing Address - Country:US
Mailing Address - Phone:914-378-8513
Mailing Address - Fax:914-378-7991
Practice Address - Street 1:127 S BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-8513
Practice Address - Fax:914-378-7991
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01578972Medicaid
NY01578972Medicaid
NYJD0P755010OtherBC/BS
NYP00123511Medicare PIN
NY01578972Medicaid
NY4200430001Medicare NSC
NYU50087Medicare UPIN