1619264462 NPI number — CHILDWAY PEDIATRIC SERVICES, INC.

Table of content: (NPI 1619264462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619264462 NPI number — CHILDWAY PEDIATRIC SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDWAY PEDIATRIC SERVICES, INC.
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:
1619264462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19446-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-808-4860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-362-4950
Provider Business Practice Location Address Fax Number:
215-997-8760
Provider Enumeration Date:
06/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JORDAN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-808-4860

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  137150 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320600000X , with the licence number: 139840 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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