Provider Demographics
NPI:1376865758
Name:JANE CANTOR, LLC
Entity Type:Organization
Organization Name:JANE CANTOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-2435
Mailing Address - Street 1:7200 LONGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2122
Mailing Address - Country:US
Mailing Address - Phone:301-315-2435
Mailing Address - Fax:301-365-6609
Practice Address - Street 1:932 HUNGERFORD DRIVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1750
Practice Address - Country:US
Practice Address - Phone:301-315-2435
Practice Address - Fax:301-365-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD485102100OtherMEDICARE
MD485102100Medicaid
MDCA6477Medicare PIN