Healthcare Provider Details

I. General information

NPI: 1174625552
Provider Name (Legal Business Name): HEALTH SERVICES OF FOX CHASE CANCER CTR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVENUE PLASTIC SURGERY ASSOC OF FCCC
PHILADELPHIA PA
19111
US

IV. Provider business mailing address

333 COTTMAN AVENUE MEDICAL STAFF OFFICE
PHILADELPHIA PA
19111
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-6900
  • Fax: 215-728-3593
Mailing address:
  • Phone: 215-728-6900
  • Fax: 215-728-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number012901
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BECK
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 215-214-1490