Healthcare Provider Details

I. General information

NPI: 1871709030
Provider Name (Legal Business Name): JAY APPLEBAUM, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 E CHAPMAN AVE
ORANGE CA
92866-2231
US

IV. Provider business mailing address

1506 E CHAPMAN AVE
ORANGE CA
92866-2231
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-8556
  • Fax: 714-538-1082
Mailing address:
  • Phone: 714-538-8556
  • Fax: 714-538-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG54219
License Number StateCA

VIII. Authorized Official

Name: JAY APPLEBAUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-538-8556