1215323845 NPI number — LAWRENCE JOSEPH CINICOLA IV DPT

Table of content: LAWRENCE JOSEPH CINICOLA IV DPT (NPI 1215323845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215323845 NPI number — LAWRENCE JOSEPH CINICOLA IV DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CINICOLA
Provider First Name:
LAWRENCE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
DPT
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:
1215323845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1265 WAYNE AVE STE 308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-801-8095
Provider Business Mailing Address Fax Number:
724-801-8147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3215 N 5TH STREET HWY
Provider Second Line Business Practice Location Address:
UNIT #4
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19605-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-509-4235
Provider Business Practice Location Address Fax Number:
484-709-2754
Provider Enumeration Date:
04/10/2015

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: 225100000X , with the licence number:  PT024196 , 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: 3931225000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50132432 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3160699 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 103008201 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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