1235393109 NPI number — LORI ILYSE GERBER DO

Table of content: LORI ILYSE GERBER DO (NPI 1235393109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235393109 NPI number — LORI ILYSE GERBER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERBER
Provider First Name:
LORI
Provider Middle Name:
ILYSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
LORI
Provider Other Middle Name:
ILYSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235393109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-6335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-6335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-807-8000
Provider Business Mailing Address Fax Number:
215-633-9710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BENSALEM BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-638-4340
Provider Business Practice Location Address Fax Number:
215-633-9710
Provider Enumeration Date:
07/10/2008

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: 207Q00000X , with the licence number:  OS014327 , 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: 6131000 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2130015 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023840270001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118141219 . This is a "WORKMAN'S COMP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30069772 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3738059000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 44130OS14327L . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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