Healthcare Provider Details

I. General information

NPI: 1760429260
Provider Name (Legal Business Name): EUGENE ANDRUCZYK, D.O., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 ROOSEVELT BLVD SUITE 404
PHILADELPHIA PA
19114-1025
US

IV. Provider business mailing address

9501 ROOSEVELT BOULEVARD SUITE 404
PHILADELPHIA PA
19114-1029
US

V. Phone/Fax

Practice location:
  • Phone: 215-676-3280
  • Fax: 215-567-3821
Mailing address:
  • Phone: 215-676-3280
  • Fax: 215-567-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE ANDRUCZYK
Title or Position: OWNER
Credential: D.O.
Phone: 215-676-3280