1548244072 NPI number — DR. HERBERT J NEVYAS M.D..

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 1548244072 NPI number — DR. HERBERT J NEVYAS M.D..

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVYAS
Provider First Name:
HERBERT
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D..
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:
1548244072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E CITY AVE
Provider Second Line Business Mailing Address:
2 BALA PLAZA
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-668-1192
Provider Business Mailing Address Fax Number:
610-668-1509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 E CITY AVE
Provider Second Line Business Practice Location Address:
2 BALA PLAZA
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-668-2777
Provider Business Practice Location Address Fax Number:
610-668-1509
Provider Enumeration Date:
11/29/2005

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: 174400000X , with the licence number:  MD006001E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD006001E , 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: 0053089000 . This is a "KEYSTONE HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006760100002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005244 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1283716 . This is a "CIGNA HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 358162 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31236E . This is a "KEYSTONE MERCY HP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A2279 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000760484 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0053089000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 180007834 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2446308 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10240MD006001E . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004411270 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 16072 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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