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General NPI Number Information
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NPI Number | 1124012828
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Entity Type | Organization
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Legal Business Name | EAST NORRITON PHYSICIANS SERVICES
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 700 DEKALB ST
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City | BRIDGEPORT
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State | PA
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Zip | 19405-1149
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Country | US
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Telephone | 610-277-6200
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Fax | 610-277-3437
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Provider Business Mailing Address
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Address Line | 1 W ELM ST SUITE 100
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2007
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Country | US
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Telephone | 610-567-6967
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Fax | 610-567-6955
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Authorized Official
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Title or Position | CFO
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Name | PETER B KENNIFF
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Credential |
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Telephone | 610-567-6967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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