1235217407 NPI number — MR. ELIO ALDO D'APPOLLONIO PT

Table of content: MR. ELIO ALDO D'APPOLLONIO PT (NPI 1235217407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235217407 NPI number — MR. ELIO ALDO D'APPOLLONIO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'APPOLLONIO
Provider First Name:
ELIO
Provider Middle Name:
ALDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
D'APPOLLONIO
Provider Other First Name:
AL
Provider Other Middle Name:
ALDO
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235217407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9836 N 22ND PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85028-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-493-5139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2423 W DUNLAP AVE
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85021-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-870-1414
Provider Business Practice Location Address Fax Number:
602-870-4141
Provider Enumeration Date:
11/02/2006

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: 225100000X , with the licence number:  831 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 831 . This is a "LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 210881 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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