1306888193 NPI number — JENNIFER HAUS PT

Table of content: JENNIFER HAUS PT (NPI 1306888193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306888193 NPI number — JENNIFER HAUS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAUS
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1306888193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 REMINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60440-4909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 W GIRARD AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-592-4033
Provider Business Practice Location Address Fax Number:
215-925-2295
Provider Enumeration Date:
06/13/2006

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: 225100000X , with the licence number:  J10001947 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT023334 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5070-0028 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64518701 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000037846 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750768 . This is a "PABS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2416646000 . This is a "IBC AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




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