Provider Demographics
NPI:1922293372
Name:EAST JEFFERSON PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:EAST JEFFERSON PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-503-6783
Mailing Address - Street 1:4300 HOUMA BLVD.
Mailing Address - Street 2:STE. 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-6791
Mailing Address - Fax:504-503-6791
Practice Address - Street 1:4300 HOUMA BLVD.
Practice Address - Street 2:STE. 202
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2924
Practice Address - Country:US
Practice Address - Phone:504-503-6791
Practice Address - Fax:504-503-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADF2307OtherRAILROAD MEDICARE
LA1337951Medicaid
LA1337951Medicaid