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General NPI Number Information
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NPI Number | 1184942898
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Entity Type | Organization
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Legal Business Name | BAIS REFUAH HEALTH CENTER LLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 77 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-4705
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Country | US
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Telephone | 917-603-8862
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Fax |
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Provider Business Mailing Address
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Address Line | 77 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-4705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK JACKNIN
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Credential |
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Telephone | 917-603-8862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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