1558439893 NPI number — ALFRED STILLMAN - HOME VISIT DOCTORS

Table of content: (NPI 1558439893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558439893 NPI number — ALFRED STILLMAN - HOME VISIT DOCTORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFRED STILLMAN - HOME VISIT DOCTORS
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:
1558439893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 VALLEY CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18017-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-884-4436
Provider Business Mailing Address Fax Number:
484-884-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PENN BLVD
Provider Second Line Business Practice Location Address:
SUITE 3026
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19144-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-7700
Provider Business Practice Location Address Fax Number:
215-849-7631
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STILLMAN
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CO PROPRIETOR
Authorized Official Telephone Number:
215-849-7700

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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