1538432968 NPI number — MR. JONATHAN MARK LEDLOW BSPSY, AACJ

Table of content: MR. JONATHAN MARK LEDLOW BSPSY, AACJ (NPI 1538432968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538432968 NPI number — MR. JONATHAN MARK LEDLOW BSPSY, AACJ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDLOW
Provider First Name:
JONATHAN
Provider Middle Name:
MARK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSPSY, AACJ
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:
1538432968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8500 LINDBERGH BLVD
Provider Second Line Business Mailing Address:
APT. #1814
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19153-1536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-921-6217
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 HICKORY RD
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-381-3093
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2012

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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