1417060922 NPI number — LESTER J. GROVERMAN,M.D.&ROBERT J. BRAUNFELD,D.O.ASSOCIATES,P.A.

Table of content: (NPI 1417060922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417060922 NPI number — LESTER J. GROVERMAN,M.D.&ROBERT J. BRAUNFELD,D.O.ASSOCIATES,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESTER J. GROVERMAN,M.D.&ROBERT J. BRAUNFELD,D.O.ASSOCIATES,P.A.
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:
6
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:
1417060922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SPROUL RD SUITE 100
Provider Second Line Business Mailing Address:
MARPLE COMMONS
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-353-3500
Provider Business Mailing Address Fax Number:
610-353-2015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SPROUL RD SUITE 100
Provider Second Line Business Practice Location Address:
MARPLE COMMONS
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-353-3500
Provider Business Practice Location Address Fax Number:
610-353-2015
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-353-3500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 135920 . This is a "MEDICARE RR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005387 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032084001 . This is a "IBC PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032084001 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008557190006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135920 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30025952 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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