1316162159 NPI number — KATHLEEN REILLY, LLC

Table of content: REBECCA LEE PROULX LMP (NPI 1285094185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316162159 NPI number — KATHLEEN REILLY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN REILLY, LLC
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:
1316162159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 N NEVILLE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15213-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-802-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 N NEVILLE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-802-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REILLY
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-802-7000

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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