1194054460 NPI number — PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC

Table of content: (NPI 1194054460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194054460 NPI number — PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC
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:
1194054460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30
Provider Second Line Business Mailing Address:
3045 N SUSQUEHANNA TRAIL
Provider Business Mailing Address City Name:
SHAMOKIN DAM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17876-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-884-3243
Provider Business Mailing Address Fax Number:
570-884-3246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 N MARKET ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-884-3243
Provider Business Practice Location Address Fax Number:
570-884-3246
Provider Enumeration Date:
12/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ASKARI
Authorized Official First Name:
HASAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-884-3243

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD436858 , 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)





Copyright © 2007-2025 www.npivalidator.com