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General NPI Number Information
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NPI Number | 1093714420
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Entity Type | Organization
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Legal Business Name | NEURO-OPHTHALMOLOGIC ASSOCIATES PC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 840 WALNUT ST SUITE 930
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5109
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Country | US
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Telephone | 215-928-3130
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Fax | 215-592-1923
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Provider Business Mailing Address
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Address Line | 840 WALNUT ST SUITE 930
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5109
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Country | US
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Telephone | 215-928-3130
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Fax | 215-592-1923
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT CHARLES SERGOTT
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Credential | MD
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Telephone | 215-928-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD031030L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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