Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACOB S. FORM, D.P.M.
Active Sole ProprietorDR. JACOB S. FORM, D.P.M. is a Podiatrist healthcare provider located in LAFAYETTE HILL, Pennsylvania. NPI 1356367494 is currently active in the NPPES registry. Verify at CMS.
Podiatrist · LAFAYETTE HILL, PA
Registration Details
- NPI Number
- 1356367494
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 14, 2006 (20.064710422128 yrs)
- Last Updated
- Apr 27, 2012
- License
-
SC002170L (PA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
4129 FRANKLIN WAYLAFAYETTE HILL, PA, 194441300Browse PA providers · Browse ZIP 19444
- Phone
- 2152922637
- Primary Specialty
-
Podiatrist
213E00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.