=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124200886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANGHORNE PHYSICAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 01/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2821 ISLAND AVE SUITE 147
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19153-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-626-9800
-----------------------------------------------------
Fax | 610-626-8856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 UNIVERSITY DR STE 106
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, REGIONAL FINANCIAL REPORTING
-----------------------------------------------------
Name | ANTHONY DOMINIC FANELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-886-6674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------