1235183658 NPI number — ACKROYD PEDIATRICS PC

Table of content: (NPI 1235183658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235183658 NPI number — ACKROYD PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACKROYD PEDIATRICS PC
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:
1235183658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 PROVIDENCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SECANE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19018-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-622-7533
Provider Business Mailing Address Fax Number:
610-622-7693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SECANE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19018-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-622-7533
Provider Business Practice Location Address Fax Number:
610-622-7693
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ACKROYD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-622-7533

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD 047071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016285280003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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