1417092297 NPI number — TRISTATE COLON AND RECTAL ASSOCIATES PC

Table of content: (NPI 1417092297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417092297 NPI number — TRISTATE COLON AND RECTAL ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRISTATE COLON AND RECTAL ASSOCIATES PC
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:
STEPHEN C. SILVER MD ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1417092297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 WEST CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-466-7882
Provider Business Mailing Address Fax Number:
610-446-3316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 WEST CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-466-7882
Provider Business Practice Location Address Fax Number:
610-446-3316
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARAI
Authorized Official First Name:
TARO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
610-446-7882

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01669001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0142807000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 889853 . This is a "PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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