1023013349 NPI number — DR. JEFFREY PHILIP SALBERG M.D.

Table of content: DR. JEFFREY PHILIP SALBERG M.D. (NPI 1023013349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023013349 NPI number — DR. JEFFREY PHILIP SALBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALBERG
Provider First Name:
JEFFREY
Provider Middle Name:
PHILIP
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:
1023013349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18370 BURBANK BLVD
Provider Second Line Business Mailing Address:
STE 601
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-2831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-996-5700
Provider Business Mailing Address Fax Number:
818-996-1649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18370 BURBANK BLVD
Provider Second Line Business Practice Location Address:
STE 601
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-2831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-996-5700
Provider Business Practice Location Address Fax Number:
818-996-1649
Provider Enumeration Date:
06/14/2005

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: 207R00000X , with the licence number:  G46132 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110061982 . This is a "RAILROAD RENDERING NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: YYY40048Y . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: T0796 . This is a "RAILROAD GROUP NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WG46132C . This is a "MEDICARE RENDERING NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: YYY40048Y , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95-3132732 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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