NPI |
1124349600 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Organization Name Legal Business Name |
ZAREPHATH INC. |
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider First Line Business Practice Location Address |
4856 E. BASELINE ROAD |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Second Line Business Practice Location Address |
SUITE 104 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
MESA |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address State Name |
AZ |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
85206 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4805186826 |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
4803619144 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
6/18/2010 |
The fax number associated with the location
address of the provider being identified. |
Last Update Date |
8/12/2022 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
LOBL |
The date that a record was last updated or changed. |
Authorized Official First Name |
MOSHE |
The first name of the authorized official. |
Authorized Official Title or Position |
CEO |
The first name of the authorized official. |
Authorized Official Telephone Number |
4805186826 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
385HR2055X |
The 10-position telephone number of the authorized official. |
Provider License Number 1 |
BH-3621 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
AZ |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
8/12/2022 |
|