Healthcare Provider Details

I. General information

NPI: 1275497356
Provider Name (Legal Business Name): PENN BA SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CAMPUS BLVD STE 100
NEWTOWN SQUARE PA
19073-3200
US

IV. Provider business mailing address

18 CAMPUS BLVD STE 100
NEWTOWN SQUARE PA
19073-3240
US

V. Phone/Fax

Practice location:
  • Phone: 929-466-1305
  • Fax:
Mailing address:
  • Phone: 929-466-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SIM B
Title or Position: MANAGER
Credential:
Phone: 347-668-9113