Provider Demographics
NPI:1124173240
Name:JLDH MEDICAL SERVICE PLLC
Entity type:Organization
Organization Name:JLDH MEDICAL SERVICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BATLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-206-1668
Mailing Address - Street 1:1487 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4002
Mailing Address - Country:US
Mailing Address - Phone:646-206-1668
Mailing Address - Fax:646-607-7778
Practice Address - Street 1:1487 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4002
Practice Address - Country:US
Practice Address - Phone:646-206-1668
Practice Address - Fax:646-607-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212090-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG80353Medicare UPIN