1629153028 NPI number — KAY & TABAS OPHTHALMOLOGY

Table of content: (NPI 1629153028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629153028 NPI number — KAY & TABAS OPHTHALMOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAY & TABAS OPHTHALMOLOGY
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:
6
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:
1629153028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE L30
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-925-6402
Provider Business Mailing Address Fax Number:
215-925-0262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MONUMENT RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-667-6760
Provider Business Practice Location Address Fax Number:
610-667-7206
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
215-925-6402

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  MD012768E , 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: 0014921990004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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