MEDICARE: PENN BA SYSTEMS

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1275497356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN BA SYSTEMS

Provider Business Mailing Address
First Line	:	18 CAMPUS BLVD STE 100
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3240
Country	:	US
Telephone Number	:	929-466-1305
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CAMPUS BLVD STE 100
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-3200
Country	:	US
Telephone Number	:	929-466-1305
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SIM B
Credential	:
Telephone Number	:	347-668-9113

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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