1548258700 NPI number — SEKINE RASNER BROCK MD PA

Table of content: JUNHONG YANG (NPI 1780332817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548258700 NPI number — SEKINE RASNER BROCK MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEKINE RASNER BROCK MD 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:
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:
1548258700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32245-7399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-262-5333
Provider Business Mailing Address Fax Number:
904-262-5337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11945 SAN JOSE BLVD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32223-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-262-5333
Provider Business Practice Location Address Fax Number:
904-262-5337
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LENTO
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
HANNAH
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
904-262-5333

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374785900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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