Organization Name: | JIB MEDICAL P.C. |
NPI Number: | 1215334321 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL E MAKOVER (CEO, CMO) |
Mailing Address: | 15811 Harry Van Arsdale Jr Ave 2nd Floor Flushing |
State: | NY US |
Postal Code: | 113653085 |
Phone Number: | 7185912400 |
Fax Number: | 7185919528 |
NPI Enumeration Date: | 12/04/2014 |
NPI Last Update Date: | 02/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |