Healthcare Provider Details

I. General information

NPI: 1588692404
Provider Name (Legal Business Name): HEALTH SERVICES OF FOX CHASE CANCER CTR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE MEDICAL ONCOLOGY ASSOC OF FCCC
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

333 COTTMAN AVE MEDICAL STAFF OFFICE
PHILADELPHIA PA
19111-2434
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-6900
  • Fax: 215-214-1405
Mailing address:
  • Phone: 215-728-6900
  • Fax: 215-214-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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