1780640177 NPI number — MR. JAMES CERVONE

Table of content: MR. JAMES CERVONE (NPI 1780640177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780640177 NPI number — MR. JAMES CERVONE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERVONE
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EYEWEAR
Provider Other First Name:
DBA QUALITY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780640177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 LINCOLN AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15202-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-766-8875
Provider Business Mailing Address Fax Number:
412-766-5760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15202-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-766-8875
Provider Business Practice Location Address Fax Number:
412-766-5760
Provider Enumeration Date:
04/25/2006

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: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017377920001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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