Provider Demographics
NPI:1598041568
Name:DOUBLE J SQUARED
Entity Type:Organization
Organization Name:DOUBLE J SQUARED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-323-8100
Mailing Address - Street 1:11110 SAN RAFAEL AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2400
Mailing Address - Country:US
Mailing Address - Phone:505-323-8100
Mailing Address - Fax:
Practice Address - Street 1:11110 SAN RAFAEL AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2400
Practice Address - Country:US
Practice Address - Phone:505-323-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90-216207L00000X
NM90-216207L00000X, 207R00000X, 208100000X, 2083X0100X, 208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty