Provider Demographics
NPI:1215972153
Name:ORLOFSKY, JACOB LEE
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:LEE
Last Name:ORLOFSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 BENT HORN CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5147
Mailing Address - Country:US
Mailing Address - Phone:972-396-1839
Mailing Address - Fax:
Practice Address - Street 1:8059 SCYENE CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-5562
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82982POtherBLUE CROSS BLUE SHIELD
TX102805202Medicaid
TXP00013020OtherRAIL ROAD
TX102805203Medicaid
TX140948401Medicaid
TX102805202Medicaid
TXP00013020OtherRAIL ROAD
TX87805HMedicare ID - Type UnspecifiedDALLAS COUNTY