1538515564 NPI number — NEW VITAE INC

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 1538515564 NPI number — NEW VITAE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW VITAE INC
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:
1538515564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1001
Provider Second Line Business Mailing Address:
5201 ST JOSEPHS ROAD
Provider Business Mailing Address City Name:
LIMEPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18060-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-965-9021
Provider Business Mailing Address Fax Number:
610-928-0174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 S 55TH STREET
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:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-499-4299
Provider Business Practice Location Address Fax Number:
267-713-7372
Provider Enumeration Date:
05/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MUTH
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, PROJECT MANAGEMENT
Authorized Official Telephone Number:
610-965-9021

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  144110 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 144110 , 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: 1007458450 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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