1497837728 NPI number — DR. BEN JAKOB D.C.,P.C

Table of content: DR. BEN JAKOB D.C.,P.C (NPI 1497837728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497837728 NPI number — DR. BEN JAKOB D.C.,P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAKOB
Provider First Name:
BEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.,P.C
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:
1497837728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 OLD COURT RD STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-6415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-580-1616
Provider Business Mailing Address Fax Number:
410-580-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 OLD COURT RD STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-6415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-580-1616
Provider Business Practice Location Address Fax Number:
410-580-1153
Provider Enumeration Date:
10/19/2006

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: 111N00000X , with the licence number:  03446 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 409827700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64763601 . This is a "MD CAREFIRST RENDERING #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K951 . This is a "CAREFIRST PROVIDER #" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 354 CB . This is a "CAREFIRST MD PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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