1962614545 NPI number — PIZZICA PEDIATRICS

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 1962614545 NPI number — PIZZICA PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIZZICA PEDIATRICS
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:
1962614545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E LEHIGH AVE
Provider Second Line Business Mailing Address:
SCHOOL OF NURSING BLDG. BASEMENT
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19125-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-707-1059
Provider Business Mailing Address Fax Number:
215-707-1049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 KING OF PRUSSIA RD
Provider Second Line Business Practice Location Address:
RADNOR STATION BLDG #2-208
Provider Business Practice Location Address City Name:
RADNOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-401-3941
Provider Business Practice Location Address Fax Number:
215-401-3941
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIZZICA
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-707-1059

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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