1508978941 NPI number — DR. MARION J HALIGOWSKI III OD

Table of content: DR. MARION J HALIGOWSKI III OD (NPI 1508978941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508978941 NPI number — DR. MARION J HALIGOWSKI III OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALIGOWSKI
Provider First Name:
MARION
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1508978941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GRANITE POINT DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-378-1344
Provider Business Mailing Address Fax Number:
610-378-5169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 NORMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-7495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-272-2161
Provider Business Practice Location Address Fax Number:
717-270-0301
Provider Enumeration Date:
08/31/2006

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: 152W00000X , with the licence number:  OEG-001196 , 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: 100888525 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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