1538322359 NPI number — JSTS PLLC

Table of content: (NPI 1538322359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538322359 NPI number — JSTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JSTS PLLC
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:
Provider Other Organization Name Type Code:
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:
1538322359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 HEMLOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03743-2426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-543-0827
Provider Business Mailing Address Fax Number:
603-543-3126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-543-0827
Provider Business Practice Location Address Fax Number:
603-543-3126
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMRKOVSKI
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
603-543-3125

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0807 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6374620001 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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