1447580584 NPI number — PENNSYLVANIA ASSOCIATES, LLC

Table of content: (NPI 1447580584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447580584 NPI number — PENNSYLVANIA ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA ASSOCIATES, LLC
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:
MOUNT POCONO MEDICAL
Provider Other Organization Name Type Code:
3
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:
1447580584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 ROUTE 73 STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-439-6111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
663 MOUNT POCONO BLVD
Provider Second Line Business Practice Location Address:
UNIT 3
Provider Business Practice Location Address City Name:
MOUNT POCONO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-7246
Provider Business Practice Location Address Fax Number:
570-839-7248
Provider Enumeration Date:
01/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TANIS
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF CONTRACT MGMT
Authorized Official Telephone Number:
856-533-8762

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  457036 , 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: 457036 . This is a "PA DEPARTMENT OF HEALTH LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com