Provider Demographics
NPI:1568948149
Name:GERALD KIMMEL JR
Entity Type:Organization
Organization Name:GERALD KIMMEL JR
Other - Org Name:LITITZ MR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-676-0307
Mailing Address - Street 1:56 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1123
Mailing Address - Country:US
Mailing Address - Phone:717-676-0307
Mailing Address - Fax:
Practice Address - Street 1:56 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1123
Practice Address - Country:US
Practice Address - Phone:717-676-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable