1578773461 NPI number — MRS. DEIDRE MARIE ANGELINI OTRL

Table of content: MRS. DEIDRE MARIE ANGELINI OTRL (NPI 1578773461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578773461 NPI number — MRS. DEIDRE MARIE ANGELINI OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGELINI
Provider First Name:
DEIDRE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOTZ
Provider Other First Name:
DEIDRE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578773461
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:
158 JUNIPER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19056-2730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-547-3809
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 N BELFIELD AVE
Provider Second Line Business Practice Location Address:
SUNNY DAYS
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-449-1600
Provider Business Practice Location Address Fax Number:
610-449-2655
Provider Enumeration Date:
05/22/2007

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:  OC006947L , 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: 001936830-0003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com