Provider Demographics
NPI:1710205745
Name:MNAP MULTIPSECIALTY GROUP
Entity Type:Organization
Organization Name:MNAP MULTIPSECIALTY GROUP
Other - Org Name:MNAP DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-673-9260
Mailing Address - Street 1:9908 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1705
Mailing Address - Country:US
Mailing Address - Phone:215-673-9260
Mailing Address - Fax:215-673-9254
Practice Address - Street 1:9908 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1705
Practice Address - Country:US
Practice Address - Phone:215-673-9260
Practice Address - Fax:215-673-9254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048245L173F00000X
PAMD422515174400000X
PAMD018061E174400000X
PAMD024403E174400000X
PAMD432721174400000X
PAMD029547E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019492480001Medicaid
PA2324240000OtherINDEPENDENCE BLUE CROSS
PA1646499OtherHIGHMARK BLUE SHIELD
PA1646499OtherHIGHMARK BLUE SHIELD