1871530170 NPI number — JEFFREY IRA SILVERSTEIN 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 1871530170 NPI number — JEFFREY IRA SILVERSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERSTEIN
Provider First Name:
JEFFREY
Provider Middle Name:
IRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASSOCIATES
Provider Other First Name:
ATLANTIC
Provider Other Middle Name:
UROLOGY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1871530170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
495 IRON BRIDGE RD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-683-1617
Provider Business Mailing Address Fax Number:
732-683-1619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
495 IRON BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-683-1617
Provider Business Practice Location Address Fax Number:
732-683-1619
Provider Enumeration Date:
06/02/2006

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: 208800000X , with the licence number:  MA056179 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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