1528365400 NPI number — 3938 GLEN DRIVE OPERATING COMPANY, LP

Table of content: (NPI 1528365400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528365400 NPI number — 3938 GLEN DRIVE OPERATING COMPANY, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3938 GLEN DRIVE OPERATING COMPANY, LP
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:
PEDIATRIC SPECIALTY CARE AT DOYLESTOWN
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:
1528365400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 MADISON AVE
Provider Second Line Business Mailing Address:
21ST FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-810-1503
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3938 GLEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18902-5436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-340-1364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOOK
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
908-236-8712

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  136670 , 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: 136670 . This is a "PENNSYLVANIA DEPARTMETN OF PUBLIC WELFARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com