Healthcare Provider Details

I. General information

NPI: 1053308932
Provider Name (Legal Business Name): JUDITH ANNE HAASE CENCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 FLORAL VALE BLVD
YARDLEY PA
19067-5515
US

IV. Provider business mailing address

903 FLORAL VALE BLVD
YARDLEY PA
19067-5515
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-6155
  • Fax: 215-860-0723
Mailing address:
  • Phone: 215-579-6155
  • Fax: 215-860-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD420401
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: