Provider Demographics
NPI:1538355045
Name:GANAPOLSKY, IRENE (LPL)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:GANAPOLSKY
Suffix:
Gender:F
Credentials:LPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SECOND STREET PIKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3830
Mailing Address - Country:US
Mailing Address - Phone:215-942-9429
Mailing Address - Fax:215-942-9432
Practice Address - Street 1:44 SECOND STREET PIKE
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3830
Practice Address - Country:US
Practice Address - Phone:215-942-9429
Practice Address - Fax:215-942-9432
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006784L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1458891OtherHIGHMARK BLUE SHIELS
PA7361760OtherAETNA
PA7361760OtherAETNA