1932438983 NPI number — BONNIE ANN JOY PAC

Table of content: BONNIE ANN JOY PAC (NPI 1932438983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932438983 NPI number — BONNIE ANN JOY PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOY
Provider First Name:
BONNIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1932438983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 OLD YORK RD
Provider Second Line Business Mailing Address:
KORMAN BUILDING ,SUITE 202
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19141-3018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-456-7000
Provider Business Mailing Address Fax Number:
215-456-5926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 OLD YORK RD
Provider Second Line Business Practice Location Address:
MOSS BUILDING, 3RD FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-3930
Provider Business Practice Location Address Fax Number:
215-456-1432
Provider Enumeration Date:
12/21/2009

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: 363AM0700X , with the licence number:  MA054235 , 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)





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