1578557401 NPI number — MATTHEW T SCALESE PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578557401 NPI number — MATTHEW T SCALESE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCALESE
Provider First Name:
MATTHEW
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1578557401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 MORGAN HWY
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
SCRANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18508-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-344-3788
Provider Business Mailing Address Fax Number:
570-969-9280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MORGAN HWY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18508-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-344-3788
Provider Business Practice Location Address Fax Number:
570-969-9280
Provider Enumeration Date:
09/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT011807L , 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: 001702320 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578557401 . This is a "UHC COMMERCIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00016183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 66866-159B . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SC974488 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578557401 . This is a "COVENTRY-HEALTH AMERICA-HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5414658 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 816686 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578557401 . This is a "HUMANA/CHOICE CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3263156 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".