Basic Information
| Provider Information | |||||||||
| NPI: | 1154637106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LANGHORNE PHYSICIAN SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JUNEWOOD MEDICAL PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 4595 NEW FALLS RD STE A | ||||||||
| Address2: | |||||||||
| City: | LEVITTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159430424 | ||||||||
| FaxNumber: | 2159438665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2010 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | PROFERA | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN DIR OF FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2157102013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0S004383L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.