1528073822 NPI number — DR. DANY YOUSSEF JABBOUR DPM

Table of content: DR. DANY YOUSSEF JABBOUR DPM (NPI 1528073822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528073822 NPI number — DR. DANY YOUSSEF JABBOUR DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JABBOUR
Provider First Name:
DANY
Provider Middle Name:
YOUSSEF
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1528073822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 MONTGOMERY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RHINEBECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12572-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-876-8637
Provider Business Mailing Address Fax Number:
845-876-0218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RHINEBECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12572-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-876-8637
Provider Business Practice Location Address Fax Number:
845-876-0218
Provider Enumeration Date:
07/29/2006

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: 213E00000X , with the licence number:  65 006140 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30061 . This is a "TAX ID LAST 5 DIGITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: GRP408871001 . This is a "BLUE SHIELD NORTHEASTERN NY GROUP PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000932161004 . This is a "BS NORTHEASTERN NY PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ2100 . This is a "RAILROAD MEDICARE GROUP PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93-2014012 . This is a "TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02911622 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: PM4111 . This is a "BLUE CROSS PRUE SHIELD PIN/IDENTIFIER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com