Provider Demographics
NPI:1588684930
Name:JENNPATH,P.C.
Entity Type:Organization
Organization Name:JENNPATH,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-527-6517
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:GRAPEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15634-0155
Mailing Address - Country:US
Mailing Address - Phone:724-527-6517
Mailing Address - Fax:724-527-6519
Practice Address - Street 1:600 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2539
Practice Address - Country:US
Practice Address - Phone:724-527-6517
Practice Address - Fax:724-527-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030402E291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory