1871921650 NPI number — MT.LEBANON ALLERGY ASSOCIATES,INC

Table of content: (NPI 1871921650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871921650 NPI number — MT.LEBANON ALLERGY ASSOCIATES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT.LEBANON ALLERGY ASSOCIATES,INC
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:
1871921650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 ENGLISH TURN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15142-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-680-3125
Provider Business Mailing Address Fax Number:
412-291-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4160 WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MCMURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-942-3106
Provider Business Practice Location Address Fax Number:
724-260-0014
Provider Enumeration Date:
10/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MINAXI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
412-680-3125

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  MD038976L , 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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