1659312858 NPI number — MARCIA KOLONGOWSKI PT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659312858 NPI number — MARCIA KOLONGOWSKI PT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KOLONGOWSKI

Provider First Name:

MARCIA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PT

Provider Gender Code:

F

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:

1659312858

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/14/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2 W 10TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MARCUS HOOK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19061-4513

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-859-8850

Provider Business Mailing Address Fax Number:

610-859-7876

Provider First Line Business Practice Location Address:

4948 PENNELL RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ASTON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19014-1867

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-494-8730

Provider Business Practice Location Address Fax Number:

610-494-9671

Provider Enumeration Date:

06/09/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  J10001530 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: 40QA00877400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: PT013157L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0879632 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 102313867 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000254533 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 07759438 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0792818000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
• Identifier: 30068646 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 87639 . This is a "HIGHMARK PABS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1659312858 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P00692901 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 057774VLZ . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".