1760825160 NPI number — MARJORIE NOLAN COHN LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760825160 NPI number — MARJORIE NOLAN COHN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARJORIE NOLAN COHN 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:
1760825160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
763 LIVEZEY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19128-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-205-2525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 S BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 1641
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19109-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-205-2525
Provider Business Practice Location Address Fax Number:
646-390-2220
Provider Enumeration Date:
04/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
MARJORIE
Authorized Official Middle Name:
NOLAN
Authorized Official Title or Position:
OWNER, REGISTERED DIETITIAN
Authorized Official Telephone Number:
267-205-2525

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN001488 , 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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