1457502106 NPI number — JUST FOR U OBGYN

Table of content: (NPI 1457502106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457502106 NPI number — JUST FOR U OBGYN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUST FOR U OBGYN
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:
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:
1457502106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S 8TH ST
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-829-7269
Provider Business Mailing Address Fax Number:
215-829-8707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-7269
Provider Business Practice Location Address Fax Number:
215-829-8707
Provider Enumeration Date:
09/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PRIOLEAU
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
215-829-7269

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD060185-L , 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: 0016889830001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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