1104363985 NPI number — PREVENTATIVE PAIN & WELLNESS OF LAFAYETTE HILL

Table of content: (NPI 1104363985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104363985 NPI number — PREVENTATIVE PAIN & WELLNESS OF LAFAYETTE HILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREVENTATIVE PAIN & WELLNESS OF LAFAYETTE HILL
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:
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:
1104363985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 SAW MILL RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDSLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10502-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-376-6100
Provider Business Mailing Address Fax Number:
914-231-6872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 GERMANTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE HILL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19444-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-376-6100
Provider Business Practice Location Address Fax Number:
914-231-6872
Provider Enumeration Date:
01/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NIELI
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
914-376-6100

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com