1639134570 NPI number — JOANNE MICHELLE KAKATY-MONZO DO

Table of content: JOANNE MICHELLE KAKATY-MONZO DO (NPI 1639134570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639134570 NPI number — JOANNE MICHELLE KAKATY-MONZO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAKATY-MONZO
Provider First Name:
JOANNE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1639134570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 OLD SENTINEL TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-7500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-420-1615
Provider Business Mailing Address Fax Number:
610-642-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 RITTENHOUSE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19003-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-420-1615
Provider Business Practice Location Address Fax Number:
610-642-1607
Provider Enumeration Date:
04/20/2006

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: 207V00000X , with the licence number:  OS012324 , 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: OS012324 . This is a "MEDICAL LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3873485 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 067549TGW . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1583457 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7631545 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0870850 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2262292000 . This is a "BCBS PA PERCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1583457 . This is a "BCBS PA HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2262292000 . This is a "BCBS PA KEYSTONEE AMERIHE" identifier . This identifiers is of the category "OTHER".




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