1629458518 NPI number — NEW START MEDICAL, LLC

Table of content: (NPI 1629458518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629458518 NPI number — NEW START MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW START MEDICAL, LLC
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:
1629458518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 CHICHESTER XING
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACUNGIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18062-8041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-698-9467
Provider Business Mailing Address Fax Number:
888-368-7986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 EASTON RD STE 1500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18976-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
674-547-1472
Provider Business Practice Location Address Fax Number:
267-454-7157
Provider Enumeration Date:
06/04/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PALLIN
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PHYSICIAN
Authorized Official Telephone Number:
919-698-9467

Provider Taxonomy Codes

  • Taxonomy code: 207RB0002X , with the licence number:  MD443483 , 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)