Healthcare Provider Details

I. General information

NPI: 1538412887
Provider Name (Legal Business Name): DISCOVER OPTIMAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 EDGMONT AVE
BROOKHAVEN PA
19015-2862
US

IV. Provider business mailing address

3605 EDGMONT AVE
BROOKHAVEN PA
19015-2862
US

V. Phone/Fax

Practice location:
  • Phone: 610-876-6180
  • Fax: 610-876-6130
Mailing address:
  • Phone: 610-876-6180
  • Fax: 610-876-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS003505L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS003505L
License Number StatePA

VIII. Authorized Official

Name: JASON WEIGNER
Title or Position: OWNER
Credential: DC
Phone: 610-876-6180