1932435021 NPI number — PENNSYLVANIA PAIN SPECIALISTS, P.C.

Table of content: (NPI 1932435021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932435021 NPI number — PENNSYLVANIA PAIN SPECIALISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA PAIN SPECIALISTS, 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:
1932435021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 STATESMAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHALFONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18914-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-688-8967
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 CHEW ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-4746
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINSTEIN
Authorized Official First Name:
GENE
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-688-8967

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  MD425455 , 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: 1016843320001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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