1851680656 NPI number — PERLL DIAGNOSTICS INC

Table of content: (NPI 1851680656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851680656 NPI number — PERLL DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERLL DIAGNOSTICS INC
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:
1851680656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5010 RITTER RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-4828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-691-1500
Provider Business Mailing Address Fax Number:
717-691-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 RITTER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-691-1500
Provider Business Practice Location Address Fax Number:
717-691-5551
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAWAZ
Authorized Official First Name:
FERYAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-394-2776

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 102599817-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102599817-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".