1851306518 NPI number — ALAN M SMOLEN DDS PC

Table of content: KAREN LOMANGAYA SEGOVIA RN (NPI 1770183311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851306518 NPI number — ALAN M SMOLEN DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN M SMOLEN DDS PC
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:
1851306518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 FLORAL VALE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YARDLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19067-5512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 FLORAL VALE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YARDLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19067-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-504-2400
Provider Business Practice Location Address Fax Number:
215-504-7450
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMOLEN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-504-2400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS020298L , 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)