1184659310 NPI number — STEVEN A NISSMAN MD

Table of content: STEVEN A NISSMAN MD (NPI 1184659310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184659310 NPI number — STEVEN A NISSMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NISSMAN
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1184659310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
699 W GERMANTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-834-1800
Provider Business Mailing Address Fax Number:
610-834-1811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
699 W GERMANTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-834-1800
Provider Business Practice Location Address Fax Number:
610-834-1811
Provider Enumeration Date:
07/12/2006

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: 207W00000X , with the licence number:  MD425959 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: MA07892400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01705 . This is a "HEALTH PARTNERS - FRANK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1381889 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101695040 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30035423 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1381889 . This is a "PREFERRED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 27807 . This is a "HEALTH PARTNERS - NORTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: I55871 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101695040 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2757673000 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P3741343 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0069477 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15876 . This is a "ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2675838000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 100187 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101659040 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1406670 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1892627 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1915176 . This is a "HIGHMARK BS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7053856 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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