Provider Demographics
NPI:1336141969
Name:MOMENTUM THERAPEUTICS
Entity Type:Organization
Organization Name:MOMENTUM THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF MOMENTUM THERAPEUTICS
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MARRAPESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-981-7303
Mailing Address - Street 1:121 NESHANNOCK TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 HIGHLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4601
Practice Address - Country:US
Practice Address - Phone:724-981-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009233E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002363OtherPA BLUE SHIELD NUMBER
PA1010802600001Medicaid
PA1010802600001Medicaid