1215084223 NPI number — PAUL W GAFFNEY

Table of content: (NPI 1215084223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215084223 NPI number — PAUL W GAFFNEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL W GAFFNEY
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:
KING OF PRUSSIA PHYSICAL THERAPY AND SPORTS INJURY CENTER
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:
1215084223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
491 ALLENDALE RD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-337-7155
Provider Business Mailing Address Fax Number:
610-337-7111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
491 ALLENDALE RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-337-7155
Provider Business Practice Location Address Fax Number:
610-337-7111
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAFFNEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-337-7155

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001755441 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2421829000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1005470 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2421829000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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