1346684602 NPI number — GAIL VANT ZELFDE, PH.D., LLC

Table of content: (NPI 1346684602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346684602 NPI number — GAIL VANT ZELFDE, PH.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAIL VANT ZELFDE, PH.D., 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:
1346684602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 E BUTLER AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
AMBLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19002-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-941-0196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 E BUTLER AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
AMBLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19002-4436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-941-0196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VANT ZELFDE
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-941-0196

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS005338L , 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: 001661409 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5616328 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0261731000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 487643000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 466001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com