Provider Demographics
NPI:1417012824
Name:R G JALBERT, INC.
Entity type:Organization
Organization Name:R G JALBERT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GASTON
Authorized Official - Last Name:JALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-683-8856
Mailing Address - Street 1:4716 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2851
Mailing Address - Country:US
Mailing Address - Phone:412-683-8856
Mailing Address - Fax:412-781-6820
Practice Address - Street 1:4716 ELLSWORTH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2851
Practice Address - Country:US
Practice Address - Phone:412-683-8856
Practice Address - Fax:412-781-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004809L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA053180Medicare ID - Type UnspecifiedMEDICARE PROVIDER