1073714010 NPI number — REGIONAL REHAB ASSOCIATES PA

Table of content: (NPI 1073714010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073714010 NPI number — REGIONAL REHAB ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL REHAB ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAFFE SPORTS MEDICINE AND REHABILITATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073714010
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 111090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108-0119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-254-7778
Provider Business Mailing Address Fax Number:
239-254-7718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1865 VETERANS PARK DR
Provider Second Line Business Practice Location Address:
SUITE# 101
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34109-0447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-254-7778
Provider Business Practice Location Address Fax Number:
239-254-7718
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAFFE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
239-254-7778

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: OS8375 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OS8375 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com