1689851305 NPI number — ERIC EGELMAN

Table of content: (NPI 1689851305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689851305 NPI number — ERIC EGELMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC EGELMAN
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:
1689851305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 WEST 8TH ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ROYAL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-527-0015
Provider Business Mailing Address Fax Number:
717-527-4183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 WEST 8TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ROYAL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-527-0015
Provider Business Practice Location Address Fax Number:
717-527-4183
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EGELMAN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
MILES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-527-0015

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  SC 003223 L , 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: 02320200 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001175146 0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120833269 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 256127 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3514070 . This is a "CZGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 480027522 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02320200 . This is a "CAPITOL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 88127 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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