1922257245 NPI number — MRS. SAMANTHA LEIGH GIMIGLIANO LICENSED PROFESSIONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922257245 NPI number — MRS. SAMANTHA LEIGH GIMIGLIANO LICENSED PROFESSIONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIMIGLIANO
Provider First Name:
SAMANTHA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED PROFESSIONA
Provider Gender Code:
F

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:
1922257245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NEUROPSYCHIATRY CENTER 300 OLD POND ROAD
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
BRIDGEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-220-7323
Provider Business Mailing Address Fax Number:
412-220-7325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 OLD POND RD (NEUROPSYCHIATRY CENTER)
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-220-7323
Provider Business Practice Location Address Fax Number:
412-220-7325
Provider Enumeration Date:
09/10/2008

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: 101YP2500X , with the licence number:  PC004934 , 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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