1467606558 NPI number — SHERRY S SHANG LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467606558 NPI number — SHERRY S SHANG LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRY S SHANG LLC
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:
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:
1467606558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 N. 9TH ST
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:
19107-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-629-8866
Provider Business Mailing Address Fax Number:
215-629-8867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
384 YORKSHIRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-335-7447
Provider Business Practice Location Address Fax Number:
610-520-1737
Provider Enumeration Date:
11/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHANG
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
412-335-7447

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  MD421264 , 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)