1558549055 NPI number — KIM M ABDALLA

Table of content: (NPI 1558549055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558549055 NPI number — KIM M ABDALLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIM M ABDALLA
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:
DR. KIM MARIE DIGIACOMO
Provider Other Organization Name Type Code:
5
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:
1558549055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2370 YORK RD
Provider Second Line Business Mailing Address:
SUITE D2
Provider Business Mailing Address City Name:
JAMISON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18929-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-343-2800
Provider Business Mailing Address Fax Number:
215-491-1750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2370 YORK RD
Provider Second Line Business Practice Location Address:
SUITE D2
Provider Business Practice Location Address City Name:
JAMISON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18929-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-343-2800
Provider Business Practice Location Address Fax Number:
215-491-1750
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DI GIACOMO
Authorized Official First Name:
KIM
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
215-343-2800

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  SC003199L , 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: 447982 . This is a "447982" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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