1568500890 NPI number — MRS. BERNADETTE LLOYD-SOBOLOW CNM

Table of content: MRS. BERNADETTE LLOYD-SOBOLOW CNM (NPI 1568500890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568500890 NPI number — MRS. BERNADETTE LLOYD-SOBOLOW CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLOYD-SOBOLOW
Provider First Name:
BERNADETTE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

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:
1568500890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-6355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-497-7520
Provider Business Mailing Address Fax Number:
610-497-7525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1560 GARRETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER DARBY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19082-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-284-3300
Provider Business Practice Location Address Fax Number:
610-284-3706
Provider Enumeration Date:
02/01/2007

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: 367A00000X , with the licence number:  MW008226L , 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: 001119951 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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