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General NPI Number Information
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NPI Number | 1447272406
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Entity Type | Individual
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Provider Name | ERIC AZVOLINSKY PAC
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 700 SPRUCE ST BSMT WEST
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4022
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Country | US
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Telephone | 215-829-3358
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 MARYLAND RD STE 504
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1226
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Country | US
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Telephone | 215-481-4836
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Fax | 215-481-5788
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA051111
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License Number State | PA
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