1780675504 NPI number — PHILIP S. PINSKER DPM PC

Table of content: (NPI 1780675504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780675504 NPI number — PHILIP S. PINSKER DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP S. PINSKER DPM PC
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:
1780675504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
853 JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-3870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-225-7410
Provider Business Mailing Address Fax Number:
724-225-9469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
853 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-3870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-225-7410
Provider Business Practice Location Address Fax Number:
724-225-9469
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PINSKER
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
724-225-7410

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC002080L , 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: 0012042660001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 441480931 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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