1316131360 NPI number — MARYWOOD UNIVERSITY

Table of content: (NPI 1316131360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316131360 NPI number — MARYWOOD UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYWOOD UNIVERSITY
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:
MARYWOOD UNIVERSITY HUMAN PERFORMANCE LABORATORY
Provider Other Organization Name Type Code:
5
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:
1316131360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 ADAMS AVENUE
Provider Second Line Business Mailing Address:
ONEILL CENTER FOR HEALTHY FAMILIES
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-340-6069
Provider Business Mailing Address Fax Number:
570-340-6067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 ADAMS AVENUE
Provider Second Line Business Practice Location Address:
ONEILL CENTER FOR HEALTHY FAMILIES
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-340-6069
Provider Business Practice Location Address Fax Number:
570-340-6067
Provider Enumeration Date:
09/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEMPSEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
570-840-2252

Provider Taxonomy Codes

  • Taxonomy code: 207PS0010X , with the licence number:  MD032293E , 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)