1013209360 NPI number — MRS. JESSICA ELIZABETH MATHIESON P.A.

Table of content: MRS. SANDRA K ARMSTRONG OT (NPI 1972539948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013209360 NPI number — MRS. JESSICA ELIZABETH MATHIESON P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHIESON
Provider First Name:
JESSICA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1013209360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
941 SOUTH AVE
Provider Second Line Business Mailing Address:
APT A29
Provider Business Mailing Address City Name:
SECANE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19018-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-764-7178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
POB #1 - SUITE 305
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-447-6021
Provider Business Practice Location Address Fax Number:
610-447-2179
Provider Enumeration Date:
05/04/2011

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:  MA054816 , 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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