| NPI | 1093776247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY GREEN Doctor 215-752-0382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA OS003032L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA OS004790L) |
| 174400000X Specialist (Licence: PA MD032401E) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2008-07-03 |