1699822676 NPI number — DR. JOAN H ZEIDMAN M.D.

Table of content: DR. JOAN H ZEIDMAN M.D. (NPI 1699822676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699822676 NPI number — DR. JOAN H ZEIDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEIDMAN
Provider First Name:
JOAN
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1699822676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-482-4795
Provider Business Mailing Address Fax Number:
856-528-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 CONESTOGA ROAD
Provider Second Line Business Practice Location Address:
SUITE 104 BUILDING NUMBER 1
Provider Business Practice Location Address City Name:
ROSEMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-525-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/04/2007

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: 207V00000X , with the licence number:  MD043259E , 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: 3716863 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0513068000 . This is a "KEYSTONE HMO AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 679020 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0513068000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4233992 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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