1598700957 NPI number — DRS. ROGOWSKI & ROGOWSKI PC

Table of content: (NPI 1598700957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598700957 NPI number — DRS. ROGOWSKI & ROGOWSKI PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. ROGOWSKI & ROGOWSKI PC
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:
1598700957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2608 ISLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19153-1827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-365-3344
Provider Business Mailing Address Fax Number:
215-492-0513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2608 ISLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19153-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-365-3344
Provider Business Practice Location Address Fax Number:
215-492-0513
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROGOWSKI
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-365-3344

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC001189-L , 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: 0683580 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18595 . This is a "ASH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0061070000 . This is a "KEY E.AMERI HEALTH.PER CH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0068358001 . This is a "AMERCHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4287169 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0973431000 . This is a "KEY.EAST.PC & AMERI HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 113855 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 48152 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1303354 . This is a "BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9339 . This is a "ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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