Provider Demographics
NPI:1902889553
Name:DREZNER, JESS R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:R
Last Name:DREZNER
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 1:2603 KEISER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3341
Mailing Address - Country:US
Mailing Address - Phone:610-678-2776
Mailing Address - Fax:610-678-5127
Practice Address - Street 1:2603 KEISER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3341
Practice Address - Country:US
Practice Address - Phone:610-678-2776
Practice Address - Fax:610-678-5127
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002144L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3980270001OtherMEDICARE DME
003572Medicare ID - Type Unspecified
T28340Medicare UPIN
3980270001Medicare NSC