Healthcare Provider Details

I. General information

NPI: 1982650594
Provider Name (Legal Business Name): WJO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 ROOSEVELT BLVD. SUITE 202
PHILADELPHIA PA
19115
US

IV. Provider business mailing address

424 MILL ST
BRISTOL PA
19007-4813
US

V. Phone/Fax

Practice location:
  • Phone: 215-826-8050
  • Fax: 215-826-8053
Mailing address:
  • Phone: 215-826-8050
  • Fax: 215-826-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE MCMANUS
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 215-757-0465