Basic Information
| Provider Information | |||||||||
| NPI: | 1871535351 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGHENIES INDEPENDENT PHYSICIANS PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | ALLEGHENIES INDEPENDENT PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 336 BLOOMFIELD ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159043271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145357576 | ||||||||
| FaxNumber: | 8145361369 | ||||||||
| Practice Location | |||||||||
| Address1: | 336 BLOOMFIELD ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159043271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145357576 | ||||||||
| FaxNumber: | 8145361369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 03/10/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FOCKLER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8142665650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD059909L | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | OS005422L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1063497584 | 01 | MUNZER, FRED NPI | OTHER | 1457336042 | 01 | NPI MARLEY | OTHER | 1518947720 | 01 | BUDAY, MICHAEL NPI NUM | OTHER | 1538160262 | 01 | PA | ADEWALE OLALERE MD NPI | OTHER | 1639154545 | 01 | GUNNLAUGSON, BRIAN NPI | OTHER | 1346225869 | 01 | AMPER, LEONARDO NPI NUM | OTHER |