1336396159 NPI number — ADVANCED OPHTHALMOLOGY EAST

Table of content: (NPI 1336396159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336396159 NPI number — ADVANCED OPHTHALMOLOGY EAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED OPHTHALMOLOGY EAST
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:
1336396159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 MOSSIDE BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-374-1220
Provider Business Mailing Address Fax Number:
412-374-8220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 MOSSIDE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-374-1220
Provider Business Practice Location Address Fax Number:
412-374-8220
Provider Enumeration Date:
08/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOUNDER
Authorized Official First Name:
RAMAKUMAR
Authorized Official Middle Name:
NATARAJAN
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
412-374-1220

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD417220 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305S00000X , with the licence number: MD417220 , 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: 001436147 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7589430 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000142774 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1533333 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000211356 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 312055 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7732705 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA17220 . This is a "VISION BENEFITS OF AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3039591 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7220 . This is a "EYEMED COLE VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019431640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065977RBR . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 180046091 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 51037 . This is a "DAVIS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com