1790882223 NPI number — JENSEN & JENSEN THERAPY P. L. L. C

Table of content: DR. CARY JAY SILBERMAN H.P. (NPI 1649409210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790882223 NPI number — JENSEN & JENSEN THERAPY P. L. L. C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENSEN & JENSEN THERAPY P. L. L. C
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:
1790882223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 E 100 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPINE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84004-1464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-763-5538
Provider Business Mailing Address Fax Number:
801-766-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 RUNNING CREEK WAY STE 150 BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHI
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84043-5673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-766-4244
Provider Business Practice Location Address Fax Number:
801-766-4245
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
801-766-4244

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  110083-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 528806842001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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