1609944370 NPI number — JENNIFER J BAK DC PC

Table of content: (NPI 1609944370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609944370 NPI number — JENNIFER J BAK DC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER J BAK DC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1609944370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE WEST WATER STREET
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-224-0010
Provider Business Mailing Address Fax Number:
781-224-0147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE WEST WATER ST
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
WAKEFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-224-0010
Provider Business Practice Location Address Fax Number:
781-224-0147
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
781-224-0010

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2125 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y39752 . This is a "GROUP BCBS MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y36545 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".




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