Healthcare Provider Details

I. General information

NPI: 1952661134
Provider Name (Legal Business Name): KIMMEL NASAL AND SINUS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 QUARRY DR SUITE E58C
WEST LAWN PA
19609-1161
US

IV. Provider business mailing address

2211 QUARRY DR SUITE E58C
WEST LAWN PA
19609-1161
US

V. Phone/Fax

Practice location:
  • Phone: 610-927-5394
  • Fax: 610-927-5796
Mailing address:
  • Phone: 610-927-5394
  • Fax: 610-927-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE FENSTERMACHER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 570-366-4606