1720182298 NPI number — MRS. MARINA SPERLING MSPT

Table of content: MRS. MARINA SPERLING MSPT (NPI 1720182298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720182298 NPI number — MRS. MARINA SPERLING MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPERLING
Provider First Name:
MARINA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHANIN
Provider Other First Name:
MARINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720182298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 BUSTLETON PIKE
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
FEASTERVILLE TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-6064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-364-0100
Provider Business Mailing Address Fax Number:
267-364-5393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 BUSTLETON PIKE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-364-0100
Provider Business Practice Location Address Fax Number:
267-364-5393
Provider Enumeration Date:
09/12/2006

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:  PT018189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251E1200X , with the licence number: PT018189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X , with the licence number: PT018189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT018189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 185955 . This is a "PABS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000254580 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1720182298 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 254580 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2762932000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30061120 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00692886 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102335990-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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