Healthcare Provider Details

I. General information

NPI: 1417712662
Provider Name (Legal Business Name): BERWYN HEALTH AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LANCASTER AVE STE 100
BERWYN PA
19312-1710
US

IV. Provider business mailing address

901 LANCASTER AVE STE 100
BERWYN PA
19312-1710
US

V. Phone/Fax

Practice location:
  • Phone: 610-251-2525
  • Fax:
Mailing address:
  • Phone: 610-251-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ZYGMUNT PORADA III
Title or Position: TREASURER
Credential:
Phone: 443-641-6227