=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639346745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELVIN TWERSKY DOPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2008
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5604 N BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-927-7806
-----------------------------------------------------
Fax | 215-927-5212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6580 SENATOR LN
-----------------------------------------------------
City | BENSALEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19020-1960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-752-5542
-----------------------------------------------------
Fax | 215-752-5542
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETER
-----------------------------------------------------
Name | DR. MELVIN Z TWERSKY
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-927-7806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS003955
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------