1528031341 NPI number — REBECCA M. HANIGOSKY, D.O.

Table of content: (NPI 1528031341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528031341 NPI number — REBECCA M. HANIGOSKY, D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBECCA M. HANIGOSKY, D.O.
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:
1528031341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 N KERRWOOD DR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-981-4960
Provider Business Mailing Address Fax Number:
724-982-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 N KERRWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-4960
Provider Business Practice Location Address Fax Number:
724-982-4350
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAXTER
Authorized Official First Name:
PAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
724-981-4960

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  OS008739L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 34005380H , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0015217190007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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