1124057898 NPI number — DR. JEFFREY BARTON GELBLUM MD

Table of content: DR. JEFFREY BARTON GELBLUM MD (NPI 1124057898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124057898 NPI number — DR. JEFFREY BARTON GELBLUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELBLUM
Provider First Name:
JEFFREY
Provider Middle Name:
BARTON
Provider Name Prefix Text:
DR.
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:
GELBLUM
Provider Other First Name:
JEFF
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124057898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9960 NW 116TH WAY STE 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-1175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-924-1311
Provider Business Mailing Address Fax Number:
786-924-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 NE 213TH ST STE 1004
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVENTURA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33180-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-936-9393
Provider Business Practice Location Address Fax Number:
305-936-9650
Provider Enumeration Date:
07/03/2006

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: 2084N0400X , with the licence number:  ME49900 , 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: 049439900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74775 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".