1508838061 NPI number — NEIL M NIREN MD

Table of content: NEIL M NIREN MD (NPI 1508838061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508838061 NPI number — NEIL M NIREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIREN
Provider First Name:
NEIL
Provider Middle Name:
M
Provider Name Prefix Text:
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:
1508838061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9102 BABCOCK BLVD
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-367-0808
Provider Business Mailing Address Fax Number:
412-366-1584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9102 BABCOCK BLVD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-367-0808
Provider Business Practice Location Address Fax Number:
412-366-1584
Provider Enumeration Date:
02/07/2006

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: 207N00000X , with the licence number:  MD025703E , 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: 070012530 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0017134200 . This is a "INDEPENDENCE BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017113660003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101724 . This is a "UPMC HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22133 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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