Healthcare Provider Details

I. General information

NPI: 1063871846
Provider Name (Legal Business Name): KNOPF RADIOLOGY AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 E,CHESTER PIKE APT F 1
RIDLEY PARK PA
19078
US

IV. Provider business mailing address

634 E CHESTER PIKE APT F 1
RIDLEY PARK PA
19078-1731
US

V. Phone/Fax

Practice location:
  • Phone: 484-470-5627
  • Fax:
Mailing address:
  • Phone: 484-470-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6352517
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number6352517
License Number StatePA

VIII. Authorized Official

Name: ZUDDY OGOGO
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 484-470-5627