Healthcare Provider Details

I. General information

NPI: 1801842273
Provider Name (Legal Business Name): WJO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 HULMEVILLE RD. SUITE 103
BENSALEM PA
19020
US

IV. Provider business mailing address

424 MILL STREET
BRISTOL PA
19007
US

V. Phone/Fax

Practice location:
  • Phone: 215-633-1750
  • Fax: 215-633-1753
Mailing address:
  • Phone: 215-826-8050
  • Fax: 215-826-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE MCMANUS
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 215-757-0465