1720554371 NPI number — MEDSTAFF RESOURCES LLC

Table of content: (NPI 1720554371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720554371 NPI number — MEDSTAFF RESOURCES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAFF RESOURCES 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:
1720554371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 WOODLAND HILLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELLERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18055-3364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-773-8334
Provider Business Mailing Address Fax Number:
573-240-9428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 E BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-773-8334
Provider Business Practice Location Address Fax Number:
573-240-9428
Provider Enumeration Date:
10/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GAHLA
Authorized Official First Name:
JATINDER
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
484-773-8334

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1026551100003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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