1457632317 NPI number — PCA EMSTAR HOLDINGS, L.P.

Table of content: ANI SEFERYAN AMFT (NPI 1851055198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457632317 NPI number — PCA EMSTAR HOLDINGS, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PCA EMSTAR HOLDINGS, L.P.
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:
Provider Other Organization Name Type Code:
6
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:
1457632317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52758
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19115-7758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-764-8800
Provider Business Mailing Address Fax Number:
215-827-5958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 GEIGER 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:
19115-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-764-8800
Provider Business Practice Location Address Fax Number:
215-827-5958
Provider Enumeration Date:
09/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROWE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL OPERATIONS MANAGER
Authorized Official Telephone Number:
215-764-8801

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  11040 , 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)





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