Healthcare Provider Details

I. General information

NPI: 1962449603
Provider Name (Legal Business Name): VALLEY FORGE SURGICAL CENTER, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W VALLEY RD SUITE 2401
WAYNE PA
19087-1824
US

IV. Provider business mailing address

950 W VALLEY RD SUITE 2401
WAYNE PA
19087-1824
US

V. Phone/Fax

Practice location:
  • Phone: 610-964-9663
  • Fax: 610-964-0536
Mailing address:
  • Phone: 610-964-9663
  • Fax: 610-964-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number16771501
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUNE AMARANT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-964-9663