Provider Demographics
NPI:1750031316
Name:JAZ ORTHO PLLC
Entity Type:Organization
Organization Name:JAZ ORTHO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AIEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AL KADI JAZAIERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:646-704-3996
Mailing Address - Street 1:300 ALEXANDER CT APT 110
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1156
Mailing Address - Country:US
Mailing Address - Phone:646-704-3996
Mailing Address - Fax:
Practice Address - Street 1:108 E LANCASTER AVE UNIT C3
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4146
Practice Address - Country:US
Practice Address - Phone:610-956-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty