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General NPI Number Information
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NPI Number | 1326565920
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Entity Type | Organization
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Legal Business Name | NAZARETH PHYSICIAN SERVICES
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 2701 HOLME AVE STE 104
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City | PHILA
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State | PA
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Zip | 19152-2029
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Country | US
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Telephone | 215-331-8897
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Fax | 215-991-2044
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Provider Business Mailing Address
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Address Line | 1 W ELM ST
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-4108
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Country | US
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Telephone | 610-567-6964
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | AMIEE BRENNAN
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Credential |
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Telephone | 610-567-6964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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