1497157630 NPI number — CENTER FOR ADVANCED VEIN THERAPY, P.C

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 1497157630 NPI number — CENTER FOR ADVANCED VEIN THERAPY, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ADVANCED VEIN THERAPY, P.C
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:
1497157630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 PHILMONT AVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
HUNTINGDON VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19006-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-728-7440
Provider Business Mailing Address Fax Number:
844-684-8346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 PHILMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
HUNTINGDON VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19006-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-728-7440
Provider Business Practice Location Address Fax Number:
844-684-8346
Provider Enumeration Date:
09/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
267-728-7440

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  OS004114L , 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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