1699834705 NPI number — NEW LIFE CARDIOVASCULAR CARE, P.C.

Table of content: (NPI 1699834705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699834705 NPI number — NEW LIFE CARDIOVASCULAR CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LIFE CARDIOVASCULAR CARE, P.C.
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:
NEW LIFE CARDIOVASCULAR AND PRIMARY
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:
1699834705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 HIGHGATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMBLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19002-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-870-4144
Provider Business Mailing Address Fax Number:
215-793-4488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 E WILLOW GROVE AVE STE 1C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENSIDE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-7968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-870-4144
Provider Business Practice Location Address Fax Number:
215-793-4488
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILBOURNE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-870-4144

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: MD050825L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2793777000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2793777000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4206 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001924524 . This is a "BSPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7185016 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30036888 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2793777000 . This is a "KEYSTONE HEALTH PLAN EAST (IBC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7176947 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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