1992795413 NPI number — DOMINIC J BONTEMPO D.O.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992795413 NPI number — DOMINIC J BONTEMPO D.O.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BONTEMPO

Provider First Name:

DOMINIC

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

D.O.

Provider Gender Code:

M

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:

1992795413

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/28/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 W ELM ST

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

CONSHOHOCKEN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19428-2007

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-567-6967

Provider Business Mailing Address Fax Number:

610-567-6170

Provider First Line Business Practice Location Address:

2705 DEKALB PIKE

Provider Second Line Business Practice Location Address:

SUITE 309

Provider Business Practice Location Address City Name:

NORRISTOWN

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19401-1852

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-277-6131

Provider Business Practice Location Address Fax Number:

610-277-4966

Provider Enumeration Date:

10/26/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  OS004390L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 35760OS004390L . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 4309685 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 232515999 . This is a "UHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0010439420002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0104394201 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2406 . This is a "BRAVO/ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30024862 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 3985917 . This is a "AETNA USH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0045161000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 232515999024 . This is a "HEALTHNET FEDERAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 000465313 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 4255212 . This is a "AETNA USH PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".