=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386954329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACOBI MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2010
-----------------------------------------------------
Last Update Date | 10/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 PELHAM PKWY S
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10461-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-918-7264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 CHURCH ST
-----------------------------------------------------
City | TARRYTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-260-8154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | SANAZ AMINI
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 832-260-8154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NW0100X
-----------------------------------------------------
Taxonomy Name | Women's Hospital
-----------------------------------------------------
License Number | 003939
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------