Provider Demographics
NPI:1952396343
Name:I BUB E WITTELS & D KARABELNIK PTRS
Entity Type:Organization
Organization Name:I BUB E WITTELS & D KARABELNIK PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-775-3316
Mailing Address - Street 1:2610 KEISER BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3333
Mailing Address - Country:US
Mailing Address - Phone:610-775-3316
Mailing Address - Fax:610-796-2962
Practice Address - Street 1:2610 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3333
Practice Address - Country:US
Practice Address - Phone:610-775-3316
Practice Address - Fax:610-796-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016241080008Medicaid
PA0016241080008Medicaid