1417148289 NPI number — KEYSTONE NEUROSENSORY CENTERS,LLC

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 1417148289 NPI number — KEYSTONE NEUROSENSORY CENTERS,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE NEUROSENSORY CENTERS,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:
1417148289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PIERCE ST
Provider Second Line Business Mailing Address:
SUITE 317
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-5149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-763-0054
Provider Business Mailing Address Fax Number:
570-763-0056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PIERCE ST
Provider Second Line Business Practice Location Address:
SUITE 317
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-763-0054
Provider Business Practice Location Address Fax Number:
570-763-0056
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HABERKERN
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
570-763-0054

Provider Taxonomy Codes

  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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