1447807177 NPI number — DANIELLE ANDRE PACYNA DPT

Table of content: DANIELLE ANDRE PACYNA DPT (NPI 1447807177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447807177 NPI number — DANIELLE ANDRE PACYNA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACYNA
Provider First Name:
DANIELLE
Provider Middle Name:
ANDRE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDRE
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447807177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD FORGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18518-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-457-4099
Provider Business Mailing Address Fax Number:
570-457-7205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HAMLIN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18427-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-689-7786
Provider Business Practice Location Address Fax Number:
570-689-7837
Provider Enumeration Date:
08/19/2019

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

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

  • Identifier: 1033938999 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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