1942254511 NPI number — UNIVERSITY NEUROSURGICAL, PC

Table of content: (NPI 1942254511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942254511 NPI number — UNIVERSITY NEUROSURGICAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY NEUROSURGICAL, PC
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:
1942254511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2630 HOLME AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19152-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-331-0126
Provider Business Mailing Address Fax Number:
215-331-0520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2630 HOLME AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-0126
Provider Business Practice Location Address Fax Number:
215-331-0520
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALEMO
Authorized Official First Name:
SAEID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-331-0126

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  MD037547L , 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: 0092191204 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010204560002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2362350000 . This is a "KEYSTONE EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30830 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00530 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30039 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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