1063402808 NPI number — WESTERN PA EYE PHYS AND SURGEONS

Table of content: (NPI 1063402808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063402808 NPI number — WESTERN PA EYE PHYS AND SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN PA EYE PHYS AND SURGEONS
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:
1063402808
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15074-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-728-5000
Provider Business Mailing Address Fax Number:
724-728-3248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15074-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-728-5000
Provider Business Practice Location Address Fax Number:
724-728-3248
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMBELLI
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
724-728-5000

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD019985E , 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: 060837 . This is a "PABS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 206043 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5470440 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E55440 . This is a "COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503486 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007420720001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180000534 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 91740 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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