1548760192 NPI number — EMEREST HEALTH OF PENNSYLVANIA LLC

Table of content: (NPI 1548760192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548760192 NPI number — EMEREST HEALTH OF PENNSYLVANIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMEREST HEALTH OF PENNSYLVANIA 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:
1548760192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6323 14TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11219-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20399 ROUTE 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-235-7788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BERNATH
Authorized Official First Name:
YANKEL
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
718-534-7600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com