1720386337 NPI number — MR. JONATHAN DANIEL MIKULAK L.S.W.

Table of content: MR. JONATHAN DANIEL MIKULAK L.S.W. (NPI 1720386337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720386337 NPI number — MR. JONATHAN DANIEL MIKULAK L.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIKULAK
Provider First Name:
JONATHAN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.S.W.
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:
1720386337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6134 HALLWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15147-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-996-6818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3063 FREEPORT RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NATRONA HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15065-1967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-766-9238
Provider Business Practice Location Address Fax Number:
724-226-0931
Provider Enumeration Date:
03/06/2011

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: 104100000X , with the licence number:  SW126542 , 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)





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