1417146887 NPI number — DYNAMIC RECOVERY AND WELLNESS LLC

Table of content: (NPI 1417146887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417146887 NPI number — DYNAMIC RECOVERY AND WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC RECOVERY AND WELLNESS 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:
1417146887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HOPE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18938-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-862-7317
Provider Business Mailing Address Fax Number:
215-862-0473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-4240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-862-7317
Provider Business Practice Location Address Fax Number:
215-862-0473
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SENYK
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT / EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
215-862-7317

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  130600 , 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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