1386924660 NPI number — IVY BETH FRAJERMAN MS CCC SLP

Table of content: NATALIE W. HAMMOND CRNA (NPI 1851333983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386924660 NPI number — IVY BETH FRAJERMAN MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAJERMAN
Provider First Name:
IVY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

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:
1386924660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 ALBERTS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18954-1026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-612-7530
Provider Business Mailing Address Fax Number:
215-613-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10521 DRUMMOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19154-3807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-7500
Provider Business Practice Location Address Fax Number:
215-613-1033
Provider Enumeration Date:
08/18/2011

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: 235Z00000X , with the licence number:  SL0061457L , 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: SL006157L . This is a "COMMONWEALTH OF PA DPT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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