1205905064 NPI number — PENNSYLVANIA PLASTIC SURGERY ASSOCIATES

Table of content: (NPI 1205905064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205905064 NPI number — PENNSYLVANIA PLASTIC SURGERY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA PLASTIC SURGERY ASSOCIATES
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:
1205905064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 EAGLEVIEW BLVD STE 300
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:
19341-1224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-280-6005
Provider Business Mailing Address Fax Number:
610-280-6008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 WALNUT STREET
Provider Second Line Business Practice Location Address:
SUITE 646W
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-629-1866
Provider Business Practice Location Address Fax Number:
215-629-3711
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAPLAN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-629-1866

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0742215000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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