1922277763 NPI number — CAMBRIDGE PEDIATRICS LANCASTER, LP

Table of content: (NPI 1922277763)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922277763 NPI number — CAMBRIDGE PEDIATRICS LANCASTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMBRIDGE PEDIATRICS LANCASTER, LP
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:
6
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:
1922277763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 217
Provider Second Line Business Mailing Address:
90 CAFFERTY RD.
Provider Business Mailing Address City Name:
POINT PLEASANT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18950-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-297-5555
Provider Business Mailing Address Fax Number:
215-297-0918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 RIDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-297-5555
Provider Business Practice Location Address Fax Number:
215-297-0918
Provider Enumeration Date:
02/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COYLE
Authorized Official First Name:
JOE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-297-5555

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  325270 , 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: 1020796660001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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