Provider Demographics
NPI:1134519499
Name:JEAN JACQUES RAJTER, M.D.,P.A.
Entity type:Organization
Organization Name:JEAN JACQUES RAJTER, M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-803-5440
Mailing Address - Street 1:PO BOX 350605
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33335-0605
Mailing Address - Country:US
Mailing Address - Phone:954-906-6000
Mailing Address - Fax:
Practice Address - Street 1:1001 S ANDREWS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1015
Practice Address - Country:US
Practice Address - Phone:954-906-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97122174400000X
FLME96997174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278050000Medicaid
FL278050000Medicaid