1124154471 NPI number — WENDY B JAFFE, PT, PLLC

Table of content: (NPI 1124154471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124154471 NPI number — WENDY B JAFFE, PT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDY B JAFFE, PT, 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:
1124154471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 INLYNNVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-268-2604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 INLYNNVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-268-2604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JAFFE
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
757-268-2604

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X , with the licence number:  2305005698 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 195322 . This is a "SOUTHEAST SERVICES, INC." identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 452542 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com