1447213939 NPI number — DR. STEPHEN M JENDZEJEC DO

Table of content: DR. STEPHEN M JENDZEJEC DO (NPI 1447213939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447213939 NPI number — DR. STEPHEN M JENDZEJEC DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENDZEJEC
Provider First Name:
STEPHEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1447213939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 LONG SANDS RD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03909-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-363-8430
Provider Business Mailing Address Fax Number:
207-351-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 LONG SANDS RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-363-8430
Provider Business Practice Location Address Fax Number:
207-351-3006
Provider Enumeration Date:
04/07/2006

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: 207Q00000X , with the licence number:  1287 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010467585 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 596163 . This is a "AETNA NONHMO GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080140515 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3646359 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MM2427 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0405236YPME01 . This is a "ANTHEM BCBS NEW HAMPSHIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 283840099 . This is a "PRIMECARE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 596163 . This is a "AETNA HMO GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: E10019 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "AETNA NONHMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: YORK083565 . This is a "ANTHEM BCBS NEW HAMPSHIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "STANDARD TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 283840099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003689 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585 . This is a "MACHIGONNE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010467585001 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".




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