1518262740 NPI number — PENN NEUROMUSCULAR DIAGNOSTICS, LLC

Table of content: (NPI 1518262740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518262740 NPI number — PENN NEUROMUSCULAR DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN NEUROMUSCULAR DIAGNOSTICS, 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:
PNDX
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:
1518262740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 N 7TH ST
Provider Second Line Business Mailing Address:
2ND FLOOR, TOWNPLACE VICTORIA
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-1880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-465-0100
Provider Business Mailing Address Fax Number:
724-465-6032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 WAYNE AVE
Provider Second Line Business Practice Location Address:
SUITE 312, 119 PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-801-8894
Provider Business Practice Location Address Fax Number:
724-465-6032
Provider Enumeration Date:
01/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ZAUCHA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
724-349-6530

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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