Organization Active NPI

Daniel Jeran D.P.M. P.C.

  • Foot & Ankle Surgery Podiatrist
  • Hauppauge, NY
National Provider Identifier
1497933006
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
N004563-1 Issued in NY
Legal business name
DANIEL JERAN D.P.M. P.C.
Practice address
521 Route 111
Suite 309
Hauppauge, NY 11788-4370
Phone
(631) 979-7654
NPI assigned
Feb 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Candy Rodriguez
Title
Manager
Phone
(631) 979-7654

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X N004563-1 NY Primary

Addresses

Primary practice location

521 Route 111
Suite 309
Hauppauge, NY 11788-4370

Mailing address

521 Route 111
Suite 309
Hauppauge, NY 11788-4370
Phone (631) 979-7654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080215000059 NY Part B Supplier - Clinic/Group Practice 5496838344 Receives reassigned benefits from 1 practitioner
Practice locations: Hauppauge, NY; Westhampton Beach, NY

National Provider Directory

National Provider Directory

Locations

521 Route 111
Ste 309
Hauppauge, NY 11788
Phone (631) 979-7654

70C Old Riverhead Rd
Westhampton Beach, NY 11978
Phone (631) 288-1106

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1497933006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 ROUTE 111",
            "address_2": "SUITE 309",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884370",
            "telephone_number": "631-979-7654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 ROUTE 111",
            "address_2": "SUITE 309",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117884370",
            "telephone_number": "631-979-7654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL JERAN D.P.M. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "CANDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "631-979-7654"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "N004563-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hauppauge, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.