Healthcare Provider Details

I. General information

NPI: 1467535773
Provider Name (Legal Business Name): AMBULATORY ENDOSCOPIC SURGICAL CENTER OF BUCKS COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OXFORD VALLEY RD SUITE 804
YARDLEY PA
19067
US

IV. Provider business mailing address

301 OXFORD VALLEY RD SUITE 804
YARDLEY PA
19067
US

V. Phone/Fax

Practice location:
  • Phone: 215-321-4700
  • Fax: 215-321-9008
Mailing address:
  • Phone: 215-321-4700
  • Fax: 215-321-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number39C0001163
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ANDREW T FANELLI
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 215-321-4700