1023617412 NPI number — NIKOLA BARASHKI MT

Table of content: NIKOLA BARASHKI MT (NPI 1023617412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023617412 NPI number — NIKOLA BARASHKI MT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARASHKI
Provider First Name:
NIKOLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT
Provider Gender Code:
M

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:
1023617412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PUTNAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18966-2731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-753-5545
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HORSHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORSHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19044-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-753-5545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2020

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: 225700000X , with the licence number:  MSG011837 , 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)