Provider Demographics
NPI:1992738439
Name:KONLIAN,O'NEILL & ASSOCIATES, P.A.
Entity type:Organization
Organization Name:KONLIAN,O'NEILL & ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-548-7600
Mailing Address - Street 1:659 S SALISBURY BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5458
Mailing Address - Country:US
Mailing Address - Phone:410-860-5910
Mailing Address - Fax:410-860-5912
Practice Address - Street 1:20684 JOHN J WILLIAMS HWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4393
Practice Address - Country:US
Practice Address - Phone:302-945-0200
Practice Address - Fax:302-945-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000035197Medicaid