Basic Information
Provider Information
NPI: 1386954329
EntityType: 2
ReplacementNPI:  
OrganizationName: JACOBI MEDICAL CENTER
LastName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 29 CHURCH ST
Address2:  
City: TARRYTOWN
State: NY
PostalCode: 105914805
CountryCode: US
TelephoneNumber: 8322608154
FaxNumber:  
Practice Location
Address1: 1400 PELHAM PKWY S
Address2:  
City: BRONX
State: NY
PostalCode: 104611138
CountryCode: US
TelephoneNumber: 7189187264
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/08/2010
LastUpdateDate: 10/05/2011
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: AMINI
AuthorizedOfficialFirstName: SANAZ
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AuthorizedOfficialTitleorPosition: PHYSICIAN
AuthorizedOfficialTelephone: 8322608154
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: M.D
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NW0100X003939NYY HospitalsGeneral Acute Care HospitalWomen

No ID Information.


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