1336120922 NPI number — RICHARD KANOFF MD

Table of content: RICHARD KANOFF MD (NPI 1336120922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336120922 NPI number — RICHARD KANOFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANOFF
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1336120922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-567-6964
Provider Business Mailing Address Fax Number:
610-567-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LANSDOWNE AVE
Provider Second Line Business Practice Location Address:
SUITE 308 MOB
Provider Business Practice Location Address City Name:
DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19023-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-534-6142
Provider Business Practice Location Address Fax Number:
610-534-6130
Provider Enumeration Date:
11/10/2005

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: 207T00000X , with the licence number:  OS003560 , 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: 0008884240004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148829 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 322006 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4595900 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0052240000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2610873 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0100215 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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