1578622072 NPI number — SHERYL ROSEN SLP

Table of content: MUJTABA AHMED (NPI 1053712687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578622072 NPI number — SHERYL ROSEN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSEN
Provider First Name:
SHERYL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

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:
1578622072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4401 PENN AVE
Provider Second Line Business Mailing Address:
3RD FLOOR ALLIGATOR POD
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15224-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 PENN AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR ALLIGATOR POD
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15224-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-692-7310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

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: 235Z00000X , with the licence number:  SL006368L , 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: 1014314090001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14374 . This is a "BRAVO ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1778246 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".