Provider Demographics
NPI:1528401700
Name:JERRY G. KAPLAN, M.D., P.C.
Entity Type:Organization
Organization Name:JERRY G. KAPLAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-597-8000
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-0273
Mailing Address - Country:US
Mailing Address - Phone:718-794-2505
Mailing Address - Fax:718-794-2511
Practice Address - Street 1:1610 WILLIAMSBRIDGE RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6289
Practice Address - Country:US
Practice Address - Phone:718-794-2505
Practice Address - Fax:718-794-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00703219Medicaid
NY05A341Medicare UPIN