Healthcare Provider Details

I. General information

NPI: 1699606038
Provider Name (Legal Business Name): CLINICAL SPECIALTY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MONUMENT RD FL 4
BALA CYNWYD PA
19004-1702
US

IV. Provider business mailing address

150 MONUMENT RD FL 4
BALA CYNWYD PA
19004-1702
US

V. Phone/Fax

Practice location:
  • Phone: 610-902-1738
  • Fax:
Mailing address:
  • Phone: 610-902-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY GRECO
Title or Position: SENIOR ENROLLMENT MANAGER
Credential:
Phone: 223-341-8516