Provider Demographics
NPI:1346399854
Name:ALAN J KIVITZ MD PC
Entity type:Organization
Organization Name:ALAN J KIVITZ MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-693-0300
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:1125 OLD RTE 220 N
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635
Mailing Address - Country:US
Mailing Address - Phone:814-693-0300
Mailing Address - Fax:814-693-0400
Practice Address - Street 1:1125 OLD RTE 220 N
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-693-0300
Practice Address - Fax:814-693-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007706880002Medicaid