1316921331 NPI number — JUAN ROSARIO PT

Table of content: JUAN ROSARIO PT (NPI 1316921331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316921331 NPI number — JUAN ROSARIO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSARIO
Provider First Name:
JUAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1316921331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 COMMERCE BLVD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DICKSON CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18519-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-489-5561
Provider Business Mailing Address Fax Number:
570-489-5563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 COMMERCE BLVD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DICKSON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18519-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-5561
Provider Business Practice Location Address Fax Number:
570-489-5563
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251E1200X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251G0304X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251H1200X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251H1300X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251N0400X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251P0200X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251S0007X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251X0800X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225400000X , with the licence number: PT004071 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 0012397620007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 819329 . This is a "FIRST PRIORITY/BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 163627 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3302361 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5868017 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 677615 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9384447 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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