1851378897 NPI number — JOLANTA E ROSZKOWSKA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851378897 NPI number — JOLANTA E ROSZKOWSKA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSZKOWSKA
Provider First Name:
JOLANTA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1851378897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBASTOPOL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39359-0150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-625-7140
Provider Business Mailing Address Fax Number:
601-625-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1488 HWY 487
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEBASTOPAL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-625-7140
Provider Business Practice Location Address Fax Number:
601-625-7199
Provider Enumeration Date:
12/30/2005

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: 207R00000X , with the licence number:  16539 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RG0300X , with the licence number: 16539 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: P00015210 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00121829 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com