1164472486 NPI number — ANDREW RUPPERSBERGER D.O.

Table of content: ANDREW RUPPERSBERGER D.O. (NPI 1164472486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164472486 NPI number — ANDREW RUPPERSBERGER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUPPERSBERGER
Provider First Name:
ANDREW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1164472486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 WOODBOURNE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19057-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-949-1125
Provider Business Mailing Address Fax Number:
215-949-6004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 WOODBOURNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEVITTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19057-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-949-1125
Provider Business Practice Location Address Fax Number:
215-949-6004
Provider Enumeration Date:
05/10/2006

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: 207Q00000X , with the licence number:  OS011909 , 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: 1012583400005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30023590 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012583400002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012583400004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2459092 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2179736000 . This is a "IBC, KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 35651 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101258340-01 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1490043 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1012583400003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1490043 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3193133 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7172572 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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