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General NPI Number Information
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NPI Number | 1730286097
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Entity Type | Organization
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Legal Business Name | PLYMOUTH MEETING AMBULATORY SURGICAL CENTER LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 625 W RIDGE PIKE BUILDING B
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1180
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Country | US
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Telephone | 610-834-9700
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Fax | 610-834-9992
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Provider Business Mailing Address
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Address Line | 625 W RIDGE PIKE BUILDING B
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1180
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Country | US
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Telephone | 610-834-9700
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Fax | 610-834-9992
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Authorized Official
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Title or Position | ADMINISTRATOR DIRECTOR OF NURSING
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Name | MR. VICTOR P KRZESINSKI
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Credential | RN
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Telephone | 610-834-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 07451500
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License Number State | PA
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