1366636466 NPI number — HOWARD JOSEFBERG MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366636466 NPI number — HOWARD JOSEFBERG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEFBERG
Provider First Name:
HOWARD
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:
1366636466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11140 ROCKVILLE PIKE
Provider Second Line Business Mailing Address:
SUITE #100-172
Provider Business Mailing Address City Name:
NORTH BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-909-8676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11140 ROCKVILLE PIKE
Provider Second Line Business Practice Location Address:
SUITE #100-172
Provider Business Practice Location Address City Name:
NORTH BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-909-8676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2007

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:  203 056 , 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: 171 7422 . This is a "MLP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 763 401 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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