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General NPI Number Information
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NPI Number | 1700115847
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Entity Type | Organization
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Legal Business Name | INTEGRATED DIABETES SERVICES LLC
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 333 E LANCASTER AVE SUITE 204
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City | WYNNEWOOD
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State | PA
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Zip | 19096-1929
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Country | US
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Telephone | 610-642-6055
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Fax | 610-642-8046
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Provider Business Mailing Address
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Address Line | 333 E LANCASTER AVE SUITE 204
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City | WYNNEWOOD
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State | PA
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Zip | 19096-1929
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Country | US
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Telephone | 610-642-6055
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Fax | 610-642-8046
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MR. GARY SCHEINER
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Credential | MS, CDE
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Telephone | 610-642-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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