1316945983 NPI number — DR. BRUCE IRWIN ACKERMAN DPM

Table of content: DR. BRUCE IRWIN ACKERMAN DPM (NPI 1316945983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316945983 NPI number — DR. BRUCE IRWIN ACKERMAN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACKERMAN
Provider First Name:
BRUCE
Provider Middle Name:
IRWIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1316945983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2417 WELSH ROAD
Provider Second Line Business Mailing Address:
STE 21 #240
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19114-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-334-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2417 WELSH ROAD
Provider Second Line Business Practice Location Address:
SUITE 21 #240
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-5700
Provider Business Practice Location Address Fax Number:
215-334-5774
Provider Enumeration Date:
07/08/2005

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: 213E00000X , with the licence number:  SC002030L , 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: 5677430 . This is a "AETNA INSURANCE ID#" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SC002030L15493 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0054016601 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060614000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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