Provider Demographics
NPI:1851348486
Name:JSE EMERGENCY MEDICAL GROUP
Entity Type:Organization
Organization Name:JSE EMERGENCY MEDICAL GROUP
Other - Org Name:JSE EMERGENCY MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ENGLANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-522-2001
Mailing Address - Street 1:DEPT 2268
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0001
Mailing Address - Country:US
Mailing Address - Phone:714-522-2001
Mailing Address - Fax:714-522-7503
Practice Address - Street 1:21530 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2608
Practice Address - Country:US
Practice Address - Phone:714-522-2001
Practice Address - Fax:714-522-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083674Medicaid
CAGR0083676Medicaid
CAGE0083675Medicaid
CAGR0083670Medicaid
CAGR0083674Medicaid