1912073495 NPI number — MRS. BETH LAMANNA MS PT

Table of content: (NPI 1750392254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912073495 NPI number — MRS. BETH LAMANNA MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMANNA
Provider First Name:
BETH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOSTICK
Provider Other First Name:
BETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912073495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 N CHURCH ST
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
HAZLE TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18202-9307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-501-1808
Provider Business Mailing Address Fax Number:
855-635-6308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 CAREY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706-5489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-0539
Provider Business Practice Location Address Fax Number:
570-829-4036
Provider Enumeration Date:
11/28/2006

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: 225100000X , with the licence number:  PT015811 , 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: 388457 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393572 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 817818 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818051 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393573 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 815880 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".




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