1861047193 NPI number — BFPS PC

Table of content: (NPI 1861047193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861047193 NPI number — BFPS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BFPS PC
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:
1861047193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 TOWN PL STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYN MAWR
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19010-3420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-762-5666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 TOWN PL STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYN MAWR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19010-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-900-2806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
BLOOM
Authorized Official First Name:
JASON
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
215-900-2806

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9547626 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3845396000 . This is a "BLUE CROSS BLUE SHIELD OF PA / PERSONAL CHOICE / KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 834539600 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2075855 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 003201614-003 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com