1881630960 NPI number — DR. MICHAEL QUINTO GIULIANI P.T. M.P.T.,PH.D.

Table of content: TAMMIE THOMAS (NPI 1801309604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881630960 NPI number — DR. MICHAEL QUINTO GIULIANI P.T. M.P.T.,PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIULIANI
Provider First Name:
MICHAEL
Provider Middle Name:
QUINTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
P.T. M.P.T.,PH.D.
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:
1881630960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 KENT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WALES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19454-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-661-8446
Provider Business Mailing Address Fax Number:
215-661-8426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 EASTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19001-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-885-2033
Provider Business Practice Location Address Fax Number:
215-885-7408
Provider Enumeration Date:
06/20/2006

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:  PT007728L , 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: 4319553 . This is a "AETNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0139879000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001073672-02 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1112852 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01618281 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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