| NPI | 1043758790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MAXIMENKO Facility Administrator 215-568-6822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 207RI0011X Internal Medicine Interventional Cardiology (Licence: PA 22371501) |
| 207RN0300X Internal Medicine Nephrology (Licence: PA 22371501) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA 22371501) | |
| 2086S0129X Surgery Vascular Surgery (Licence: PA 22371501) | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2018-07-25 |