1497967376 NPI number — DR. TAL BEN HAZAN

Table of content: DR. TAL BEN HAZAN (NPI 1497967376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497967376 NPI number — DR. TAL BEN HAZAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZAN
Provider First Name:
TAL
Provider Middle Name:
BEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1497967376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4790 BARKLEY CIR BLDG A
Provider Second Line Business Mailing Address:
BARKLEY SURGERY CENTER, INC.
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-7543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-275-8882
Provider Business Mailing Address Fax Number:
239-275-6304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4420 LAKE BOONE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-7505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-791-2040
Provider Business Practice Location Address Fax Number:
919-791-2041
Provider Enumeration Date:
05/04/2007

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: 207RG0100X , with the licence number:  ME107950 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 2024-02680 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3059409 . This is a "UHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7646900 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 149RS . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9439370 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 002901300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com