1831390343 NPI number — EARLY PSYCHIATRIC & COUNSELING SERVICE, P.C

Table of content: (NPI 1831390343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831390343 NPI number — EARLY PSYCHIATRIC & COUNSELING SERVICE, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARLY PSYCHIATRIC & COUNSELING SERVICE, P.C
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:
1831390343
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN TOP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18707-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-454-2545
Provider Business Mailing Address Fax Number:
570-454-6191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
W HAZLETON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18202-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-454-2545
Provider Business Practice Location Address Fax Number:
570-454-6191
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAHMAN
Authorized Official First Name:
SHAFIQ
Authorized Official Middle Name:
UR
Authorized Official Title or Position:
PRESIDENT-CHIEF PSYCHIATRIST
Authorized Official Telephone Number:
570-454-2545

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD053911-L , 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: 0015129990009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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