1578501045 NPI number — PT CHEZ VOUS, INC.

Table of content: (NPI 1578501045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578501045 NPI number — PT CHEZ VOUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PT CHEZ VOUS, INC.
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:
1578501045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHAMPTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18966-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-266-8288
Provider Business Mailing Address Fax Number:
215-947-4141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 HUNTINGDON PIKE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-266-8288
Provider Business Practice Location Address Fax Number:
215-947-4141
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISH
Authorized Official First Name:
ALINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-266-8288

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30010 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1997180 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 711662 . This is a "ACN (UNITED HEALTHCARE)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019169380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17895 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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