1578666954 NPI number — DR. RICHARD BJELDANES HEEP PHD

Table of content: ALLYSON MATTHYS (NPI 1144751041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578666954 NPI number — DR. RICHARD BJELDANES HEEP PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEEP
Provider First Name:
RICHARD
Provider Middle Name:
BJELDANES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1578666954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 YORKTOWN PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-885-4775
Provider Business Mailing Address Fax Number:
215-885-4776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 YORKTOWN PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-885-4775
Provider Business Practice Location Address Fax Number:
215-885-4776
Provider Enumeration Date:
09/07/2006

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: 103TC0700X , with the licence number:  PS002972L , 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: 0111230000 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4416517 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3413980 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272557 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01403724 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62003 . This is a "UBH" identifier . This identifiers is of the category "OTHER".




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