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General NPI Number Information
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NPI Number | 1417712662
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Entity Type | Organization
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Legal Business Name | BERWYN HEALTH AND WELLNESS PC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 901 LANCASTER AVE STE 100
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City | BERWYN
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State | PA
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Zip | 19312-1710
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Country | US
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Telephone | 610-251-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 901 LANCASTER AVE STE 100
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City | BERWYN
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State | PA
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Zip | 19312-1710
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Country | US
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Telephone | 610-251-2525
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. ZYGMUNT PORADA III
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Credential |
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Telephone | 443-641-6227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) 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 | 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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