1033487962 NPI number — JFD MEDICAL PLLC

Table of content: (NPI 1033487962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033487962 NPI number — JFD MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JFD MEDICAL PLLC
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:
Provider Other Organization Name Type Code:
6
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:
1033487962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 ROUTE 378
Provider Second Line Business Mailing Address:
PO BOX 429
Provider Business Mailing Address City Name:
CENTER VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18034-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-966-9667
Provider Business Mailing Address Fax Number:
610-966-9660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
EMMAUS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18049-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-966-9667
Provider Business Practice Location Address Fax Number:
610-966-9660
Provider Enumeration Date:
12/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DURRANI
Authorized Official First Name:
JAMEEL
Authorized Official Middle Name:
FARRUKH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
484-602-8753

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  MD426228 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: MD426228 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: MD 426228 , 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: 1012685510001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 820732 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 93891 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1732838 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7073539 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2378460 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: H94914 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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