NPIMap

Organization Active NPI

Aquahab, LP

  • Nutrition Education Nutritionist
  • Phila, PA
National Provider Identifier
1679718191
Registry record updated Dec 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition Education NutritionistTaxonomy code 133NN1002X
License
DN002660 Issued in PA
Legal business name
AQUAHAB, LP
Practice address
3600 Grant Ave
Phila, PA 19114-2630
Phone
(215) 677-0400
Fax
(215) 671-1837
NPI assigned
Dec 12, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2008

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

Authorized official

Name
Deborah Siedlecki
Title
Billing Supervisor
Phone
(215) 677-0400

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X DN002660 PA Primary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X DN003739 PA
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X DN003889 PA

Addresses

Primary practice location

3600 Grant Ave
Phila, PA 19114-2630

Mailing address

3600 Grant Ave
Phila, PA 19114-2630
Phone (215) 677-0400

Other identifiers 1

IdentifierTypeStateIssuer
2864330000OtherPAINDEPENDENCE BLUE CROSS

Other names 1

  • AQUAHAB PHYSICAL THERAPY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aquahab LP3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3600 Grant Ave
Philadelphia, PA 19114
Phone (215) 677-0400

NPI Registry JSON

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1679718191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 GRANT AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191142630",
            "telephone_number": "215-677-0400",
            "fax_number": "215-671-1837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 GRANT AVE",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191142630",
            "telephone_number": "215-677-0400",
            "fax_number": "215-671-1837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUAHAB, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-12",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "SIEDLECKI",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "215-677-0400"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PA",
            "license": "DN002660",
            "primary": true
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PA",
            "license": "DN003739",
            "primary": false
        },
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "PA",
            "license": "DN003889",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2864330000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AQUAHAB PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phila, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.