1679525422 NPI number — DR. JEFF CLAUDE CONFORTI DPT

Table of content: DR. JEFF CLAUDE CONFORTI DPT (NPI 1679525422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679525422 NPI number — DR. JEFF CLAUDE CONFORTI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONFORTI
Provider First Name:
JEFF
Provider Middle Name:
CLAUDE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

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:
1679525422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 NORTH 7TH STREET
Provider Second Line Business Mailing Address:
CONFORTI PHYSICAL THERAPY AND FITNESS CENTER
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-731-6094
Provider Business Mailing Address Fax Number:
717-731-6199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 NORTH 7TH STREET
Provider Second Line Business Practice Location Address:
CONFORTI PHYSICAL THERAPY AND FITNESS CENTER
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-731-6094
Provider Business Practice Location Address Fax Number:
717-731-6199
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  DAPT000241 , 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: 678594 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02032401 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".