MEDICARE: DELORES A VANJONACK MSS, RDCS, RCS, RVS

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	2085U0001X	Diagnostic Ultrasound Physician	70015	PA

General Provider Information

NPI Number	:	1750994422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES A VANJONACK MSS, RDCS, RCS, RVS

Provider Business Mailing Address
First Line	:	2094 FLOWING SPRINGS RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-2632
Country	:	US
Telephone Number	:	215-939-0668
Fax Number	:	732-993-7700

Provider Business Practice Location Address
First Line	:	2094 FLOWING SPRINGS RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-2632
Country	:	US
Telephone Number	:	215-939-0668
Fax Number	:	732-993-7700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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