Healthcare Provider Details

I. General information

NPI: 1598758401
Provider Name (Legal Business Name): EAST NORRITON PHYSICIANS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 S BROAD ST BLDG E
LANSDALE PA
19446-5338
US

IV. Provider business mailing address

1 W ELM ST SUITE 100
CONSHOHOCKEN PA
19428-2007
US

V. Phone/Fax

Practice location:
  • Phone: 215-542-9700
  • Fax: 215-362-7024
Mailing address:
  • Phone: 610-567-6967
  • Fax: 610-567-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER B KENNIFF
Title or Position: CFO
Credential:
Phone: 610-567-6967