1003907965 NPI number — PENNSYLVANIA NEUROLOGICAL ASSOCIATES LTD

Table of content: (NPI 1003907965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003907965 NPI number — PENNSYLVANIA NEUROLOGICAL ASSOCIATES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA NEUROLOGICAL ASSOCIATES LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003907965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 LOWTHER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-2012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-774-2202
Provider Business Mailing Address Fax Number:
717-774-2634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 LOWTHER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-774-2202
Provider Business Practice Location Address Fax Number:
717-774-2634
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NULL
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
717-774-2202

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD045352E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: MD046124L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD069690L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD073033L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083679559 . This is a "NPI INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1174588644 . This is a "NPI INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 049923NOC . This is a "MEDICARE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1861456675 . This is a "NPI INDIV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1427009521 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".