1144335464 NPI number — GRUENDEL EANS PC

Table of content: (NPI 1144335464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144335464 NPI number — GRUENDEL EANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUENDEL EANS PC
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:
DRS. GRUENDEL, EANS & YOUNG
Provider Other Organization Name Type Code:
3
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:
1144335464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3506 5TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-621-0200
Provider Business Mailing Address Fax Number:
412-621-9414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3506 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-621-0200
Provider Business Practice Location Address Fax Number:
412-621-9414
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
FRONT OFFICE/ INS. COORD
Authorized Official Telephone Number:
412-621-0200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS016567L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: DS019246L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0700X , with the licence number: DS024036L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DS019246L . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DS024036L . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DS042054 . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DS039211 . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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