| NPI | 1851803514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA SUSAN PETRILLO Clinical Administrator 610-751-3509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: PA DSO16246L) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DSO16246L) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-02 |