Healthcare Provider Details

I. General information

NPI: 1558550830
Provider Name (Legal Business Name): VALLEY FORGE FACIAL PLASTIC SURGERY ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

206 GAY ST
PHOENIXVILLE PA
19460-3721
US

IV. Provider business mailing address

206 GAY ST
PHOENIXVILLE PA
19460-3721
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-8896
  • Fax: 610-326-6160
Mailing address:
  • Phone: 610-933-8896
  • Fax: 610-326-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY A FEINER
Title or Position: SECRETARY-TREASURER
Credential: MD
Phone: 610-323-1550