1184641714 NPI number — DR. RICHARD I MINTZ DO

Table of content: DR. RICHARD I MINTZ DO (NPI 1184641714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184641714 NPI number — DR. RICHARD I MINTZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINTZ
Provider First Name:
RICHARD
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1184641714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7622 OGONTZ AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19150-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-224-8980
Provider Business Mailing Address Fax Number:
215-224-9342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7622 OGONTZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19150-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-8980
Provider Business Practice Location Address Fax Number:
215-224-9342
Provider Enumeration Date:
07/17/2006

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: 207R00000X , with the licence number:  0S003583L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 0S003583L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 25MB05998400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0060155000 . This is a "KE65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 018210S003583L . This is a "HLTHD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 018210S003583L . This is a "SRHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008238500001 . This is a "DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0008238500005 . This is a "DPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0055111000 . This is a "KE65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0060155000 . This is a "PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 018210S003583L . This is a "HLTHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00087018 . This is a "RRMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0060155001 . This is a "KEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161767 . This is a "BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0060155000 . This is a "PC65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1034655 . This is a "KMHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0055111000 . This is a "PC65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0055111001 . This is a "PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01821 . This is a "SRHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161767 . This is a "BLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0055111000 . This is a "KEY65" identifier . This identifiers is of the category "OTHER".




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