Basic Information
Provider Information | |||||||||
NPI: | 1669453601 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WARHAFTIG | ||||||||
FirstName: | JEREMY | ||||||||
MiddleName: | P | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 75 WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | NORWELL | ||||||||
State: | MA | ||||||||
PostalCode: | 020619147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7818785200 | ||||||||
FaxNumber: | 7816819901 | ||||||||
Practice Location | |||||||||
Address1: | 75 WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | NORWELL | ||||||||
State: | MA | ||||||||
PostalCode: | 020619147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7818785200 | ||||||||
FaxNumber: | 7816819901 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/08/2005 | ||||||||
LastUpdateDate: | 01/10/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 208026 | MA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 0024473 | 01 | MA | NEIGHBORHOOD HLTH PLAN | OTHER | 208026 | 01 | MA | TUFTS | OTHER | 208026 | 01 |   | TUFTS MEDICARE PREFERRED | OTHER | 0118826 | 05 | MA |   | MEDICAID | 04 2297845 | 01 | MA | DOC FIRST | OTHER | 7548601 | 01 | MA | AETNA | OTHER | 04 2297845 | 01 | MA | TRICARE | OTHER | B10506001 | 01 | MA | CIGNA | OTHER | 04 2297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 04 2297845 | 01 | MA | GIC UNICARE | OTHER | 04 2297845 | 01 | MA | GREAT WEST HEALTH CARE | OTHER | 04 2297845 | 01 | MA | HCVM | OTHER | 62139 | 01 | MA | FALLON | OTHER | J23652 | 01 | MA | BCBS | OTHER | 04 2297845 | 01 | MA | UNITED HEALTH CARE | OTHER | 204111 | 01 | MA | HVD PILGRIM HEALTH CARE | OTHER |