1659517571 NPI number — JAYANTI PROFESSIONAL CORPORATION

Table of content: (NPI 1659517571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659517571 NPI number — JAYANTI PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAYANTI PROFESSIONAL CORPORATION
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:
1659517571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2654 SW 32ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-7847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-854-7444
Provider Business Mailing Address Fax Number:
352-873-6647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2654 SW 32ND PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-7847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-854-7444
Provider Business Practice Location Address Fax Number:
352-671-5313
Provider Enumeration Date:
12/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PANCHAL
Authorized Official First Name:
JAYANTI
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
352-854-7444

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5701051 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009734700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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