Healthcare Provider Details

I. General information

NPI: 1063498269
Provider Name (Legal Business Name): JOHN G SHERTZ JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY SHERTZ

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S BROAD ST
PHILADELPHIA PA
19148-3542
US

IV. Provider business mailing address

PO BOX 8500 2345
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-952-9323
  • Fax: 215-952-1496
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN268871L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: