1831444983 NPI number — MRS. DANIELLE L AZAR DPT

Table of content: MRS. DANIELLE L AZAR DPT (NPI 1831444983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831444983 NPI number — MRS. DANIELLE L AZAR DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZAR
Provider First Name:
DANIELLE
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALANTE
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831444983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 W GERMANTOWN PIKE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-0370
Provider Business Mailing Address Fax Number:
610-270-0374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
686 DEKALB PIKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BLUE BELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19422-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-270-0300
Provider Business Practice Location Address Fax Number:
610-270-8863
Provider Enumeration Date:
07/16/2012

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: 2251X0800X , with the licence number:  PT022161 , 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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