1841299641 NPI number — PAUL C KONITZKY DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841299641 NPI number — PAUL C KONITZKY DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KONITZKY

Provider First Name:

PAUL

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

M

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:

1841299641

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/28/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2006 MAXWELL LN

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MARS

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

16046-2136

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

724-816-1626

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

115 NOLTE DRIVE EXT

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

KITTANNING

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

16201-7159

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-545-8000

Provider Business Practice Location Address Fax Number:

724-543-4370

Provider Enumeration Date:

07/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  OS012144 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00027281201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02664313 . This is a "NY MEDICAL ASSISTANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2581933 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00244567 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1068906 . This is a "WEST VIRGINIA WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 1746297 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1545621 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 170154 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1013305780001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 410779 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".