1942236120 NPI number — MITCHELL D SHIKOFF D.P.M.

Table of content: MITCHELL D SHIKOFF D.P.M. (NPI 1942236120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942236120 NPI number — MITCHELL D SHIKOFF D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIKOFF
Provider First Name:
MITCHELL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

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:
1942236120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 BENSALEM BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENSALEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19020-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-638-4446
Provider Business Mailing Address Fax Number:
215-638-4447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BENSALEM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-638-4446
Provider Business Practice Location Address Fax Number:
215-638-4447
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  SC002651L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: SC002651L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0990080 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1616230 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0023162000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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