1295795656 NPI number — DR. GARY A PACYNA D.P.M.

Table of content: DR. GARY A PACYNA D.P.M. (NPI 1295795656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295795656 NPI number — DR. GARY A PACYNA D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACYNA
Provider First Name:
GARY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1295795656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 DRINKER TPKE STE 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18444-7948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-842-0400
Provider Business Mailing Address Fax Number:
570-842-1449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 DRINKER TPKE STE 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18444-7948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-842-0400
Provider Business Practice Location Address Fax Number:
570-842-1449
Provider Enumeration Date:
03/27/2006

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: 213ER0200X , with the licence number:  SC003408L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: SC003408L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: SC003408L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 0649380001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: SC003408L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0211163000 . This is a "BC PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8193207 . This is a "UNISYS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 30263 5822 . This is a "GEISINGER GOLD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 073911 . This is a "BLUE SHIELD HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 476121 . This is a "FIRST PRIORITY FOR LIFE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 74559 . This is a "MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0649380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0575152 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 480012183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y8325 . This is a "PHS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30263 5822 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com