1902961253 NPI number — DR. J. LEAH GARLAN DC INC

Table of content: (NPI 1902961253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902961253 NPI number — DR. J. LEAH GARLAN DC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. J. LEAH GARLAN DC 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:
PENNRIDGE WELLNESS CENTER
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:
1902961253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMING GLEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18911-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-257-3938
Provider Business Mailing Address Fax Number:
215-257-3646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1281 RT 113 UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMING GLEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-257-3938
Provider Business Practice Location Address Fax Number:
215-257-3646
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARLAN
Authorized Official First Name:
JOHANNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-257-3938

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC 008808 , 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: 076343WK2 . This is a "MEDICARE ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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