1023084837 NPI number — ELENA C. CASANOVA-GHOSH CRNP

Table of content: ELENA C. CASANOVA-GHOSH CRNP (NPI 1023084837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023084837 NPI number — ELENA C. CASANOVA-GHOSH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASANOVA-GHOSH
Provider First Name:
ELENA
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMES
Provider Other First Name:
ELENA
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023084837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE 356 LANKENAU MOB EAST
Provider Business Mailing Address City Name:
WYNNEWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19096-3450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-476-8210
Provider Business Mailing Address Fax Number:
610-552-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 356 LANKENAU MOB EAST
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-476-8210
Provider Business Practice Location Address Fax Number:
610-552-0029
Provider Enumeration Date:
02/23/2006

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: 364S00000X , with the licence number:  VP006089P , 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)

  • Identifier: 232359401 . This is a "MAIN LINE HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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