1679570741 NPI number — JEFFREY MARK KAPLAN MD

Table of content: JODI MACKEY (NPI 1285229229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679570741 NPI number — JEFFREY MARK KAPLAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPLAN
Provider First Name:
JEFFREY
Provider Middle Name:
MARK
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:
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:
1679570741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23625 COMMERCE PARK
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-255-5725
Provider Business Mailing Address Fax Number:
866-618-2917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
398 KINGSTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11961-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-255-5725
Provider Business Practice Location Address Fax Number:
866-618-2917
Provider Enumeration Date:
07/05/2005

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: 2085R0202X , with the licence number:  ME83134 , 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: 808187700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102324628 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00193664 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100078610 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7617022 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000576200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2771193 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2763997 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200933260 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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