1750577037 NPI number — DELAWARE VALLEY ENT CORPORATION

Table of content: MATTHEW JACOBSON PT, DPT, ATC (NPI 1992161178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750577037 NPI number — DELAWARE VALLEY ENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE VALLEY ENT CORPORATION
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:
1750577037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9557
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19809-0557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-427-2444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1508 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806-4338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-427-2444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COKER
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
FRANCISCA
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
630-291-2013

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  C10008417 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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