1164013140 NPI number — KEYSTONE ALLERGY AND ASTHMA CENTER PC

Table of content: (NPI 1164013140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164013140 NPI number — KEYSTONE ALLERGY AND ASTHMA CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE ALLERGY AND ASTHMA CENTER PC
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:
1164013140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/18/2021
NPI Reactivation Date:
07/31/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 EXTON CMNS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-897-7143
Provider Business Mailing Address Fax Number:
484-328-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 EXTON COMMONS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-890-9990
Provider Business Practice Location Address Fax Number:
610-890-9991
Provider Enumeration Date:
02/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
GHELANI
Authorized Official First Name:
SUJAL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
484-897-7143

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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