Provider Demographics
NPI:1174717227
Name:JEROLD T. LITOFF, A PROFESSIONAL CORP.
Entity type:Organization
Organization Name:JEROLD T. LITOFF, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:LITOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-706-1235
Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-706-1235
Mailing Address - Fax:818-706-2378
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:SUITE 107
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-706-1235
Practice Address - Fax:818-706-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29343207X00000X, 204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293430Medicaid
CAA29343Medicare PIN
CAA25723Medicare UPIN