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General NPI Number Information
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NPI Number | 1720083553
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Entity Type | Organization
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Legal Business Name | ON SITE HEALTH SERVICES PC
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 482 NORRISTOWN RD SUITE 111
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City | BLUE BELL
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State | PA
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Zip | 19422-2349
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Country | US
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Telephone | 610-825-8210
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Fax | 610-825-8208
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Provider Business Mailing Address
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Address Line | 490 NORRISTOWN RD STE 151
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City | BLUE BELL
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State | PA
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Zip | 19422-2350
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Country | US
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Telephone | 610-825-8210
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Fax | 610-825-8208
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Authorized Official
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Title or Position | OWNER DIRECTOR ACTIVE, ATTENDING
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Name | GARY ITZENSON
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Credential | O.D
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Telephone | 610-825-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00437400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE006115T
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License Number State | PA
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