Provider Demographics
NPI:1396409181
Name:MASSENBURG, JALAL (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JALAL
Middle Name:
Last Name:MASSENBURG
Suffix:
Gender:M
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 76
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0001
Mailing Address - Country:US
Mailing Address - Phone:437-900-4188
Mailing Address - Fax:
Practice Address - Street 1:PFAELZER RING 9
Practice Address - Street 2:
Practice Address - City:THALEISCHWEILER-FROSCHEN
Practice Address - State:RHINELAND-PALATINATE
Practice Address - Zip Code:66987
Practice Address - Country:DE
Practice Address - Phone:437-900-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist