Dalton, Jack F

Dalton, Jack F is an individual health care provider with primary practice located at 106-14 70Th Avenue , Forest Hills NY 11375. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Dalton, Jack F can be contacted via phone (718) 520-6620.

Contact Information

Primary practice address
106-14 70Th Avenue Forest Hills NY 11375
Phone: (718) 520-6620
Fax: (718) 520-6630
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 112564 New York

Profile Details

NPI number 1619947082
LBN Legal business name Dalton, Jack F
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Jan 11th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619947082 NPPES
New York Other 113089245 TAX ID
New York Other NS1640 TAX ID
New York Other 176007 TAX ID
New York Other 24706P TAX ID
New York Other 4C8348 TAX ID
New York Other 0041437 TAX ID
New York MEDICAID 00881847 TAX ID

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