1609932904 NPI number — DR. JEFFREY H. KRAVITZ ED.D.

Table of content: DR. JEFFREY H. KRAVITZ ED.D. (NPI 1609932904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609932904 NPI number — DR. JEFFREY H. KRAVITZ ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAVITZ
Provider First Name:
JEFFREY
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRAVITZ
Provider Other First Name:
YAACOV
Provider Other Middle Name:
JEFFREY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1609932904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 TOWANDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELROSE PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027-2932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-635-3011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 TOWANDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-635-3011
Provider Business Practice Location Address Fax Number:
215-635-3011
Provider Enumeration Date:
12/29/2006

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: 103T00000X , with the licence number:  PS005526L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 455808000 . This is a "MAGELLAN MIS NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7035296 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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