1396013199 NPI number — MRS. KEELEY WRAY ROSENTHAL LSW

Table of content: MRS. KEELEY WRAY ROSENTHAL LSW (NPI 1396013199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396013199 NPI number — MRS. KEELEY WRAY ROSENTHAL LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENTHAL
Provider First Name:
KEELEY
Provider Middle Name:
WRAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRAY
Provider Other First Name:
KEELEY
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396013199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 HAMPSHIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELLERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18960-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-546-6763
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMBLER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19002-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-643-7676
Provider Business Practice Location Address Fax Number:
215-643-4715
Provider Enumeration Date:
12/07/2011

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: 104100000X , with the licence number:  SW126891 , 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)





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