1881922292 NPI number — KENNETH VARANO DO INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881922292 NPI number — KENNETH VARANO DO INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH VARANO DO INC.
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:
BODYLOGICMD OF PHILADELPHIA
Provider Other Organization Name Type Code:
3
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:
1881922292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 CROTON RD
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-3176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-278-3697
Provider Business Mailing Address Fax Number:
877-278-3698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 CROTON RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
KING OF PRUSSIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19406-3176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-278-3697
Provider Business Practice Location Address Fax Number:
877-278-3698
Provider Enumeration Date:
11/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VARANO
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
877-278-3697

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OS009028L , 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)





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