Healthcare Provider Details

I. General information

NPI: 1528019700
Provider Name (Legal Business Name): JIDEX GLOBAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 5TH AVE SUITE C-234
NEW YORK NY
10001-7604
US

IV. Provider business mailing address

540 SAINT JOHNS PL 2-E
BROOKLYN NY
11238-5533
US

V. Phone/Fax

Practice location:
  • Phone: 800-603-6354
  • Fax: 866-306-0179
Mailing address:
  • Phone: 917-338-6277
  • Fax: 866-306-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ORIBABOR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-603-6354