1780003533 NPI number — ALEXANDRA C CANTOR CRNP

Table of content: ALEXANDRA C CANTOR CRNP (NPI 1780003533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780003533 NPI number — ALEXANDRA C CANTOR CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTOR
Provider First Name:
ALEXANDRA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

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:
1780003533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 WOODLAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-988-8020
Provider Business Mailing Address Fax Number:
717-221-5567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 SAINT CHARLES WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-812-2390
Provider Business Practice Location Address Fax Number:
717-812-2388
Provider Enumeration Date:
04/09/2014

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: 363LF0000X , with the licence number:  SP013754 , 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: 102926830 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".