1578666954 NPI number — DR. RICHARD BJELDANES HEEP PHD

Table of content: DR. RICHARD BJELDANES HEEP PHD (NPI 1578666954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578666954 NPI number — DR. RICHARD BJELDANES HEEP PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEEP
Provider First Name:
RICHARD
Provider Middle Name:
BJELDANES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

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:
1578666954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 YORKTOWN PLAZA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-885-4775
Provider Business Mailing Address Fax Number:
215-885-4776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 YORKTOWN PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-885-4775
Provider Business Practice Location Address Fax Number:
215-885-4776
Provider Enumeration Date:
09/07/2006

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: 103TC0700X , with the licence number:  PS002972L , 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: 0111230000 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4416517 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3413980 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272557 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01403724 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62003 . This is a "UBH" identifier . This identifiers is of the category "OTHER".




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