1528296282 NPI number — AMANDA BETH COCCI DPT

Table of content: (NPI 1306276928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528296282 NPI number — AMANDA BETH COCCI DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCCI
Provider First Name:
AMANDA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEIGH
Provider Other First Name:
AMANDA
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528296282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1377 MOTOR PKWY
Provider Second Line Business Mailing Address:
STE 307
Provider Business Mailing Address City Name:
ISLANDIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11749-5258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-580-5200
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8019 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19136-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-338-8900
Provider Business Practice Location Address Fax Number:
215-338-8923
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT019897 , 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)

  • Identifier: 102373130-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2123200 . This is a "HIGHMARK PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528296282 . This is a "BRAVO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3744632000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 306177 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".




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