1205894219 NPI number — ALAN ERWIN DONNENFELD M.D.

Table of content: ALAN ERWIN DONNENFELD M.D. (NPI 1205894219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205894219 NPI number — ALAN ERWIN DONNENFELD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONNENFELD
Provider First Name:
ALAN
Provider Middle Name:
ERWIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205894219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-482-4795
Provider Business Mailing Address Fax Number:
856-528-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E LANCASTER AVE
Provider Second Line Business Practice Location Address:
353 MEDICAL OFFICE BUILDING EAST
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-9021
Provider Business Practice Location Address Fax Number:
610-649-8058
Provider Enumeration Date:
05/02/2006

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: 207SG0201X , with the licence number:  25MA04955700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: 205012-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: C1-0006729 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: 153714 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: 037414 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207SG0201X , with the licence number: MD027052E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: MD027052E , 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: 096008 . This is a "BC/BS SHIELD HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2330386000 . This is a "BC/BS KEY, PER. GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30018989 . This is a "KEYSTONE MERCY GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33657 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3716959 . This is a "AETNA US HEALTHCARE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3971180 . This is a "AETNA US HEALTHCARE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1652891 . This is a "BC/BS HIGHMARK GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00108294 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0078843000 . This is a "BC/BS KEYSTONE, PERSONAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33658 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33659 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30023531 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4100924 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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