1457657124 NPI number — ABOVE AND BEYOND COUNSELING SERVICES OF PA, LLC

Table of content: (NPI 1457657124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457657124 NPI number — ABOVE AND BEYOND COUNSELING SERVICES OF PA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOVE AND BEYOND COUNSELING SERVICES OF PA, 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:
1457657124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 BLOOMFIELD AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07044-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-239-0948
Provider Business Mailing Address Fax Number:
973-696-8323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1655 MANHEIM PIKE
Provider Second Line Business Practice Location Address:
OB-4
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-239-0948
Provider Business Practice Location Address Fax Number:
973-696-8323
Provider Enumeration Date:
01/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SEWELL
Authorized Official First Name:
WYNANTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
717-679-7142

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  37FI00160200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 37PC00350800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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