1558386342 NPI number — LEONARD HALTRECHT

Table of content: (NPI 1558386342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558386342 NPI number — LEONARD HALTRECHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONARD HALTRECHT
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:
1558386342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1999 SPROUL RD
Provider Second Line Business Mailing Address:
STE 21
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-353-5840
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1999 SPROUL RD
Provider Second Line Business Practice Location Address:
STE 21
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-353-5840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASEY
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
610-353-5840

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS002378L , 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: 041839 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232187546 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007336180001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6548 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 015630208 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032051001 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com