1255625513 NPI number — DR. NAVDEEP SINGH JASSAL M.D.

Table of content: DR. NAVDEEP SINGH JASSAL M.D. (NPI 1255625513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255625513 NPI number — DR. NAVDEEP SINGH JASSAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASSAL
Provider First Name:
NAVDEEP
Provider Middle Name:
SINGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1255625513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1417 LAKELAND HILLS BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33805-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-513-7246
Provider Business Mailing Address Fax Number:
863-333-4007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1417 LAKELAND HILLS BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-513-7246
Provider Business Practice Location Address Fax Number:
863-333-4007
Provider Enumeration Date:
06/04/2011

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: 2081P2900X , with the licence number:  273186 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: ME 122237 , 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)

  • Identifier: 150HR . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P01510619 . This is a "RR MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 015208900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".