1659345429 NPI number — MOGERMAN JASON ORTHOPAEDIC INSTITUTE,LLC

Table of content: (NPI 1659345429)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659345429 NPI number — MOGERMAN JASON ORTHOPAEDIC INSTITUTE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOGERMAN JASON ORTHOPAEDIC INSTITUTE,LLC
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:
1659345429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27A WOODLANDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYMART
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18472-9366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-488-9880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27A WOODLANDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYMART
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18472-9366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-488-9880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOGERMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SOLO
Authorized Official Telephone Number:
570-488-9880

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001880725 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1343003 . This is a "BS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com