1447203138 NPI number — DR. FRED RAYMOND HIMMELSTEIN MD

Table of content: DR. FRED RAYMOND HIMMELSTEIN MD (NPI 1447203138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447203138 NPI number — DR. FRED RAYMOND HIMMELSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIMMELSTEIN
Provider First Name:
FRED
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1447203138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203 BARN HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19382-2334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-429-9702
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
JENNERSVILLE REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
WEST GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19390-9499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-869-1000
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
05/17/2006

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: 207P00000X , with the licence number:  MD024348E , 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: 000949860 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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