Healthcare Provider Details

I. General information

NPI: 1548625833
Provider Name (Legal Business Name): RESILIENT RNFA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FROST LN
NEWTOWN PA
18940-2010
US

IV. Provider business mailing address

117 FROST LN
NEWTOWN PA
18940-2010
US

V. Phone/Fax

Practice location:
  • Phone: 215-962-9924
  • Fax: 215-860-3130
Mailing address:
  • Phone: 215-962-9924
  • Fax: 215-860-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number26NR17086200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number26NR17086200
License Number StateNJ

VIII. Authorized Official

Name: BEVERLY ANNE COCOZZA
Title or Position: OWNER
Credential: RNFA
Phone: 215-962-9924