1154470862 NPI number — HARESH & PRIYA PUNJABI MDPC

Table of content: (NPI 1154470862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154470862 NPI number — HARESH & PRIYA PUNJABI MDPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARESH & PRIYA PUNJABI MDPC
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:
HARESH & PRIYA PUNJABI MDPC
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:
1154470862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
689 LONGVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-427-3343
Provider Business Mailing Address Fax Number:
215-322-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-3343
Provider Business Practice Location Address Fax Number:
215-427-0533
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PUNJABI
Authorized Official First Name:
PRIYA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
215-427-3343

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD038932L , 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: 00839466-02 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00839635-02 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com