Pacific Nephrology Group a Professional Medical Corporation

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

PACIFIC NEPHROLOGY GROUP A PROFESSIONAL MEDICAL CORPORATION

Practice address

182 Industrial Rd
Glen Rock, PA 17327-8626

Phone

(717) 235-9352

Fax

(717) 235-4024

NPI assigned

Mar 22, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Salam Ishak, MD

Title

Owner

Phone

(619) 219-1161

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275004800000",
    "number": "1609190529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 GATEWAY CENTER WAY",
            "address_2": "SUITE 207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024500",
            "telephone_number": "619-219-1161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 INDUSTRIAL RD",
            "city": "GLEN ROCK",
            "state": "PA",
            "postal_code": "173278626",
            "telephone_number": "717-235-9352",
            "fax_number": "717-235-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NEPHROLOGY GROUP A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-22",
        "last_updated": "2010-05-28",
        "status": "A",
        "authorized_official_last_name": "ISHAK",
        "authorized_official_first_name": "SALAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-219-1161",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.