=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699967315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRY M KANEFSKY MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2007
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 LANGHORNE NEWTOWN RD SUITE 302
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-752-3035
-----------------------------------------------------
Fax | 215-752-2017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 LANGHORNE NEWTOWN RD SUITE 302
-----------------------------------------------------
City | LANGHORNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19047-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-752-3035
-----------------------------------------------------
Fax | 215-752-2017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TERRY M KANEFSKY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 215-752-3035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD015888E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------