1053786863 NPI number — GEORG ASSOCIATES

Table of content: (NPI 1053786863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053786863 NPI number — GEORG ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORG ASSOCIATES
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:
1053786863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 W SEDGWICK ST
Provider Second Line Business Mailing Address:
SUITE A106
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19119-3045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-324-8370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1518 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 607
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-324-8370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GEORG
Authorized Official First Name:
LOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
484-324-8370

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC004689 , 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: 12359148 . This is a "NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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