1639297468 NPI number — JBS MEDICAL PA

Table of content: (NPI 1639297468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639297468 NPI number — JBS MEDICAL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JBS MEDICAL PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANDREW ROSENTHAL MD
Provider Other Organization Name Type Code:
3
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:
1639297468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7280 W PALMETTO PARK RD STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-3401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-393-8800
Provider Business Mailing Address Fax Number:
561-393-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7280 W PALMETTO PARK RD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-393-8800
Provider Business Practice Location Address Fax Number:
561-393-6202
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENTHAL
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-393-8800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME89367 , 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: 7468622 . This is a "AETNA PROVIDER # FOR ANDREW ROSENTHAL, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27842 . This is a "BCBS PROVIDER FOR ANDREW ROSENTHAL,MD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38257 . This is a "BCBS GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16548 . This is a "BCBS NON-PAR PROVIDER # FOR MATTHEW GOODWIN, MD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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