1063692374 NPI number — JOSEPH J DEVENUTO JR., P.C.

Table of content: (NPI 1063692374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063692374 NPI number — JOSEPH J DEVENUTO JR., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH J DEVENUTO JR., P.C.
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:
1063692374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
485 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-3403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-345-6100
Provider Business Mailing Address Fax Number:
215-345-4151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-6100
Provider Business Practice Location Address Fax Number:
215-345-4151
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEVENUTO
Authorized Official First Name:
JANENE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
215-345-6100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD009403E , 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: 0073819470003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0021926000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 119720 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20692 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4247589 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1030535 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".




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