1922172253 NPI number — HANACHE AND LASOTA MD ASSOC

Table of content: (NPI 1922172253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922172253 NPI number — HANACHE AND LASOTA MD ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANACHE AND LASOTA MD ASSOC
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:
1922172253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1003
Provider Second Line Business Mailing Address:
11 HORSESHOE LANE
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-296-5022
Provider Business Mailing Address Fax Number:
610-640-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 HORSESHOE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301-0909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-296-5022
Provider Business Practice Location Address Fax Number:
610-640-4598
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANACHE
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ASSOCIATE
Authorized Official Telephone Number:
610-296-5022

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD008076E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD007091E , 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: 1025167 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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