=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124115092
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON SQUARE ENDOSCOPY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 11/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 W WASHINGTON SQ 4TH FL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19106-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-829-3561
-----------------------------------------------------
Fax | 215-829-5654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 W WASHINGTON SQ 4TH FL
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19106-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | FRANCIS J DUFRAYNE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-829-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------