1417034802 NPI number — CHRISTOPHER H WISE PT

Table of content: CHRISTOPHER H WISE PT (NPI 1417034802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417034802 NPI number — CHRISTOPHER H WISE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
H
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:
1417034802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15050 KUTZTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KUTZTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19530-9275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-683-5686
Provider Business Mailing Address Fax Number:
610-683-8773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15050 KUTZTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUTZTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19530-9275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-683-5686
Provider Business Practice Location Address Fax Number:
610-683-8773
Provider Enumeration Date:
11/01/2006

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:  PT007644L , 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: 1417034802 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50083550 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0716259000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0716259000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417034802 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WI20742 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 422764 . This is a "HEALTH AMER/HEALTH ASSUR." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000020742 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417034802 . This is a "BERKSHIRE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417034802 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0716259000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417034802 . This is a "PHCS/MULTIPLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com