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NPI Code Detail

MEDICARE: VALLEY ADVANCED GAMMA KNIFE, LLC

MEDICARE: VALLEY ADVANCED GAMMA KNIFE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1043294820
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALLEY ADVANCED GAMMA KNIFE, LLC
Provider Business Mailing Address
First Line : PO BOX 12848
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-0848
Country : US
Telephone Number : 610-253-7444
Fax Number : 610-253-5771
Provider Business Practice Location Address
First Line : 2407 BUTLER ST
Second Line :
City : EASTON
State : PA
Zip : 18042-5302
Country : US
Telephone Number : 610-253-7444
Fax Number : 610-253-5771
Authorized Official
Title or Position : PRINCIPAL
Name : MR. MARK GABRIEL
Credential :
Telephone Number : 317-634-2222
Provider Enumeration Date : 12/05/2005
Last Update Date : 08/22/2020

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Directions to “VALLEY ADVANCED GAMMA KNIFE, LLC ” Practice Location

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