1538111471 NPI number — LATIFA JANICE JALALI DEGRAFT-JOHNSON M.D.

Table of content: LATIFA JANICE JALALI DEGRAFT-JOHNSON M.D. (NPI 1538111471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538111471 NPI number — LATIFA JANICE JALALI DEGRAFT-JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEGRAFT-JOHNSON
Provider First Name:
LATIFA
Provider Middle Name:
JANICE JALALI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JALALI
Provider Other First Name:
LATIFA
Provider Other Middle Name:
JANICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538111471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
442 5TH AVE # 1788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-2794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 E 84TH ST APT 9E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10028-5608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-222-3260
Provider Business Practice Location Address Fax Number:
305-363-5044
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  237874 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME105724 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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