1679569255 NPI number — JOSEPH P CARDINALE DO

Table of content: JOSEPH P CARDINALE DO (NPI 1679569255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679569255 NPI number — JOSEPH P CARDINALE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDINALE
Provider First Name:
JOSEPH
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1679569255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
879 S ARLINGTON AVE
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17109-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-657-1424
Provider Business Mailing Address Fax Number:
717-657-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
879 S ARLINGTON AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-657-1424
Provider Business Practice Location Address Fax Number:
717-657-8887
Provider Enumeration Date:
09/20/2005

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: 208600000X , with the licence number:  05003804L , 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: 510370 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03024900 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006398210001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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