1295180719 NPI number — MISTAL DEBORAH J DO PC

Table of content: (NPI 1295180719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295180719 NPI number — MISTAL DEBORAH J DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISTAL DEBORAH J DO 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:
1295180719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 W FOOTHILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRUMS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18222-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-788-5000
Provider Business Mailing Address Fax Number:
570-788-2325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 W FOOTHILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRUMS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18222-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-5000
Provider Business Practice Location Address Fax Number:
570-788-2325
Provider Enumeration Date:
05/03/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MISTAL
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-788-5000

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  OS005335-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)