Provider Demographics
NPI:1366557969
Name:LOUIS J SIMONETTI DO PC
Entity type:Organization
Organization Name:LOUIS J SIMONETTI DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-454-9488
Mailing Address - Street 1:168 W RIDGE PIKE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1778
Mailing Address - Country:US
Mailing Address - Phone:610-454-9488
Mailing Address - Fax:610-409-8744
Practice Address - Street 1:168 W RIDGE PIKE
Practice Address - Street 2:SUITE 220
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1778
Practice Address - Country:US
Practice Address - Phone:610-454-9488
Practice Address - Fax:610-409-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006144L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASI161664Medicare ID - Type Unspecified
PAD77438Medicare UPIN