1205928124 NPI number — JOSE JESSURUN-SOLOMOU MD

Table of content: JOSE JESSURUN-SOLOMOU MD (NPI 1205928124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205928124 NPI number — JOSE JESSURUN-SOLOMOU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JESSURUN-SOLOMOU
Provider First Name:
JOSE
Provider Middle Name:
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:
1205928124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E 68TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10065-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-746-6481
Provider Business Mailing Address Fax Number:
212-746-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 E 68TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10065-4870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-746-6481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

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: 207ZP0102X , with the licence number:  266154-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 082727 . This is a "FAIRIVEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 101360 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 768180 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP22292 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 661388800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0038590 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11-00014 . This is a "MEDICA-PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4T513JE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1010329 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1124548 . This is a "MEDICA-CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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