1093870024 NPI number — PRECISION PAIN MANAGEMENT CENTER, P.C.

Table of content: (NPI 1093870024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093870024 NPI number — PRECISION PAIN MANAGEMENT CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION PAIN MANAGEMENT CENTER, 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:
1093870024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2325 MARYLAND RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WILLOW GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19090-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-657-9393
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 MARYLAND RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-657-9393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FERRARA
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-657-9393

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: MD067744 , 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: 001652570 . This is a "HIGHMARK - DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2791607000 . This is a "KEYSTONE GRP DR. FERRARA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2795219000 . This is a "KEYSTONE GRP DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205883139 . This is a "NPI# DR. FERRARA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0872975000 . This is a "KEYSTONE INDIVIDUAL ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1386758670 . This is a "NPI# DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1062226 . This is a "CIGNA ASHN DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2329279000 . This is a "KEYSTONE INDV # DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7402268 . This is a "CIGNA DR. EAGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1231975 . This is a "CIGNA DR. FERRARA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00950467 . This is a "00950467" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".