1669454419 NPI number — UPPER SAUCON AMB CORP

Table of content: (NPI 1669454419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669454419 NPI number — UPPER SAUCON AMB CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER SAUCON AMB CORP
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:
1669454419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5560 CAMP MEETING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTER VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18034-8401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-282-1565
Provider Business Mailing Address Fax Number:
610-282-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5560 CAMP MEETING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18034-8401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-282-1565
Provider Business Practice Location Address Fax Number:
610-282-1954
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COZZOLINO
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
610-282-1565

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04127 , 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: 0012083540 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280208 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20026672 . This is a "AMERIHEALTH MERCY HP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50003846 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0041378000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1062531 . This is a "KEYSTONE MERCY HP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 280208 . This is a "KEYSTONE HEALTH PLAN CENT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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