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General NPI Number Information
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NPI Number | 1760775282
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Entity Type | Organization
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Legal Business Name | TPS II OF PA, LLC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 245 N 15TH ST NCB ROOM 7502
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1101
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Country | US
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Telephone | 215-762-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 900 IRVINGTON PL
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City | CHESTER
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State | PA
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Zip | 19013-5216
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Country | US
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Telephone | 484-678-8690
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | MARY GENEVIEVE D'AGOSTINO
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Credential | CRNA
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Telephone | 484-678-8690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN559969
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License Number State | PA
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