1972782233 NPI number — MRS. LEORA BEACCO KALOWSKY MED CCCSLP

Table of content: MRS. LEORA BEACCO KALOWSKY MED CCCSLP (NPI 1972782233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972782233 NPI number — MRS. LEORA BEACCO KALOWSKY MED CCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALOWSKY
Provider First Name:
LEORA
Provider Middle Name:
BEACCO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MED CCCSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEACCO
Provider Other First Name:
LEORA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED CCCSLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1972782233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 WALNUT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGARLOAF
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-788-3502
Provider Business Mailing Address Fax Number:
570-788-7311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 WALNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGARLOAF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-3502
Provider Business Practice Location Address Fax Number:
570-788-7311
Provider Enumeration Date:
11/02/2007

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: 235Z00000X , with the licence number:  SL001930L , 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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