1093783409 NPI number — DR. NEIL L ISDANER M.D.

Table of content: DR. NEIL L ISDANER M.D. (NPI 1093783409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093783409 NPI number — DR. NEIL L ISDANER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISDANER
Provider First Name:
NEIL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1093783409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7602 CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19111-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-745-7411
Provider Business Mailing Address Fax Number:
215-745-7488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7602 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-745-7411
Provider Business Practice Location Address Fax Number:
215-745-7488
Provider Enumeration Date:
03/10/2006

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: 174400000X , with the licence number:  MD017922E , 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: 47074 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 05971 . This is a "USHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0052872000 . This is a "KEYSTONE/PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com