1245292309 NPI number — ANDREW M WAKSTEIN D.O.

Table of content: ANDREW M WAKSTEIN D.O. (NPI 1245292309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245292309 NPI number — ANDREW M WAKSTEIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAKSTEIN
Provider First Name:
ANDREW
Provider Middle Name:
M
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:
1245292309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 FRANKLIN AVE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
PALMERTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18071-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-824-5050
Provider Business Mailing Address Fax Number:
610-824-5053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PALMERTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18071-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-824-5050
Provider Business Practice Location Address Fax Number:
610-824-5053
Provider Enumeration Date:
04/04/2006

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: 207YX0901X , with the licence number:  OS008560L , 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: 3Y1476 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 818551 . This is a "BLUE CARE/FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9601794 . This is a "GHI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 596729 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3184601 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015442860004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134975 . This is a "MEDPLUS/UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 73747 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00008002 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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