1043228513 NPI number — JOHN G GIACALONE CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043228513 NPI number — JOHN G GIACALONE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN G GIACALONE CORP
Provider Last Name:
Provider First Name:
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:
6
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:
1043228513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 N 9TH ST STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18360-9266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-234-0283
Provider Business Mailing Address Fax Number:
570-290-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 N 9TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-9266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-234-0283
Provider Business Practice Location Address Fax Number:
570-290-8458
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIACALONE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
570-234-0283

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003545L , 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: 38MC00344600 . This is a "LICENSE/REGISTRATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5102380001 . This is a "CIGNA HEALTH INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 819420 . This is a "FIRST PRIORITY HEALTH INS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 601757500 . This is a "PA DEPTMENT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P2948333 . This is a "OXFORD INSURANCE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1505642 . This is a "HYMARKBLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5897700 . This is a "GHI HEALTH INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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