1205802337 NPI number — ROBERTA C EISENBERG MSW BCD

Table of content: ROBERTA C EISENBERG MSW BCD (NPI 1205802337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205802337 NPI number — ROBERTA C EISENBERG MSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENBERG
Provider First Name:
ROBERTA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW BCD
Provider Gender Code:
F

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:
1205802337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 E GREENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSDOWNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-622-3109
Provider Business Mailing Address Fax Number:
215-284-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 E GREENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-622-3109
Provider Business Practice Location Address Fax Number:
215-284-2191
Provider Enumeration Date:
02/28/2006

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: 104100000X , with the licence number:  CW002214L , 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: G45862 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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