=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831342765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACOBI MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2008
-----------------------------------------------------
Last Update Date | 10/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 532 E 82ND ST APT 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-7124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-620-7997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 532 E 82ND ST APT 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-7124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-620-7997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR, DEPARTMENT OF INTERN
-----------------------------------------------------
Name | MISS PENNY ROBERTS
-----------------------------------------------------
Credential | MPA
-----------------------------------------------------
Telephone | 718-918-5643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------