1770560633 NPI number — MR. ANDREW M SCHRAG BSC PT

Table of content: MR. ANDREW M SCHRAG BSC PT (NPI 1770560633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770560633 NPI number — MR. ANDREW M SCHRAG BSC PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHRAG
Provider First Name:
ANDREW
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
BSC PT
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:
1770560633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15050 KUTZTOWN RD
Provider Second Line Business Mailing Address:
P.O. BOX 210
Provider Business Mailing Address City Name:
KUTZTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19530-9275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-683-5686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 TUNNEL RD
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-0182
Provider Business Practice Location Address Fax Number:
570-622-3192
Provider Enumeration Date:
12/30/2005

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: 225100000X , with the licence number:  PT013084L , 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: 50073174 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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