Healthcare Provider Details

I. General information

NPI: 1003193046
Provider Name (Legal Business Name): PENNSYLVANIA INSTITUTE OF ENDOCRINOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR SUITE 206
LITITZ PA
17543-7507
US

IV. Provider business mailing address

1575 HIGHLANDS DR SUITE 206
LITITZ PA
17543-7507
US

V. Phone/Fax

Practice location:
  • Phone: 717-568-8886
  • Fax: 717-627-2727
Mailing address:
  • Phone: 717-568-8886
  • Fax: 717-627-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102656403-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: TIPU FAIZ M. SALEEM
Title or Position: OWNER
Credential: MD
Phone: 717-568-8886