1518857424 NPI number — BLACKBIRD CLINICAL SERVICES

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 1518857424 NPI number — BLACKBIRD CLINICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACKBIRD CLINICAL SERVICES
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:
1518857424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-202-0751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CENTURY PKWY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-278-9248
Provider Business Practice Location Address Fax Number:
610-770-1805
Provider Enumeration Date:
07/03/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARBER
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
623-980-9997

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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