1578749875 NPI number — A. JAY BINDER, M.D., A MEDICAL CORPORATION

Table of content: (NPI 1578749875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578749875 NPI number — A. JAY BINDER, M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A. JAY BINDER, M.D., A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578749875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4720 S I 10 SERVICE RD W
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70001-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-885-8225
Provider Business Mailing Address Fax Number:
504-885-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4720 S I 10 SERVICE RD W
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-885-8225
Provider Business Practice Location Address Fax Number:
504-885-7642
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BINDER
Authorized Official First Name:
A.
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
504-885-8225

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  018738 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 173833900 . This is a "DOL" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: B2775 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1362727 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK5377 . This is a "MEDICARE RR" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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