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General NPI Number Information
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NPI Number | 1336474642
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Entity Type | Individual
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Provider Name | EILEEN MORAN FERGUSON R.P.A.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 2301 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9155
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Fax | 215-952-5011
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Provider Business Mailing Address
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Address Line | 1217 IRIS AVE
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-9516
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Country | US
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Telephone | 856-262-8745
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Fax | 856-262-8745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | 06NJ1211
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License Number State | NJ
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