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General NPI Number Information
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NPI Number | 1023396199
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Entity Type | Organization
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Legal Business Name | PENN STAT INC.
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Dates
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Enumeration Date | 07/23/2011
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 465 PIKE RD UNIT 117
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1620
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Country | US
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Telephone | 215-900-0375
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Fax |
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Provider Business Mailing Address
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Address Line | 465 PIKE RD UNIT 117
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1620
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Country | US
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Telephone | 215-900-0375
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ABDUL MUMITH
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Credential |
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Telephone | 215-900-0375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State | PA
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