1962980300 NPI number — BIODXX, INC. Feryal Nawaz

Table of content: SHARITA LA'DAWN MADISON RRT (NPI 1043801418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962980300 NPI number — BIODXX, INC. Feryal Nawaz

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
BIODXX, INC.
Provider Last Name:
Nawaz
Provider First Name:
Feryal
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:
1962980300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BIANCA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-1878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-394-2776
Provider Business Mailing Address Fax Number:
717-691-5551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 RITTER RD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055-4828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-691-1500
Provider Business Practice Location Address Fax Number:
717-691-5551
Provider Enumeration Date:
07/28/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAWAZ
Authorized Official First Name:
NAVA
Authorized Official Middle Name:
KIZILBASH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-394-2776

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1015871790002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".