1639280456 NPI number — EASTERN PENNSYLVANIA CRNA SERVICES

Table of content: (NPI 1639280456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639280456 NPI number — EASTERN PENNSYLVANIA CRNA SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN PENNSYLVANIA CRNA SERVICES
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:
1639280456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINNAMINSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08077-5737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-829-1371
Provider Business Mailing Address Fax Number:
856-829-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 COTTMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-742-6972
Provider Business Practice Location Address Fax Number:
215-742-7051
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
NURSE ANESTHETIST
Authorized Official Telephone Number:
856-829-1371

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN159329L , 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: 3272535 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0298587000 . This is a "INDEPENDANCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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