Provider Demographics
NPI:1831649573
Name:JAAK MEDICAL SUPPLY
Entity Type:Organization
Organization Name:JAAK MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZINOVIY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRADLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-629-5225
Mailing Address - Street 1:2 RESERVOIR CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1391
Mailing Address - Country:US
Mailing Address - Phone:410-978-8236
Mailing Address - Fax:410-983-3950
Practice Address - Street 1:2 RESERVOIR CIR STE 102
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1391
Practice Address - Country:US
Practice Address - Phone:410-978-8236
Practice Address - Fax:410-983-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies