1336409119 NPI number — LIGHTHOUSE PSYCHIATRY, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336409119 NPI number — LIGHTHOUSE PSYCHIATRY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTHOUSE PSYCHIATRY, PC
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:
1336409119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-2250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-340-2686
Provider Business Mailing Address Fax Number:
215-340-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-2250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-340-2686
Provider Business Practice Location Address Fax Number:
215-340-4858
Provider Enumeration Date:
05/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BENZIO
Authorized Official First Name:
KARL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-340-2686

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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)