1124070776 NPI number — KAREN A DEKLEVA-REBOTTINI MASTERS

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 1124070776 NPI number — KAREN A DEKLEVA-REBOTTINI MASTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEKLEVA-REBOTTINI
Provider First Name:
KAREN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTERS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEKLEVA
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MASTERS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124070776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4051 OLD WILLIAM PENN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15668-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-733-8313
Provider Business Mailing Address Fax Number:
724-733-8313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4051 OLD WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15668-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-733-8313
Provider Business Practice Location Address Fax Number:
724-733-8313
Provider Enumeration Date:
05/16/2006

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: 103TC0700X , with the licence number:  PS003084-L , 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)





Copyright © 2007-2024 www.npivalidator.com