Basic Information
| Provider Information | |||||||||
| NPI: | 1285057026 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RUNQUIST | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 695 US HIGHWAY 46 | ||||||||
| Address2: | STE 400A | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738268291 | ||||||||
| FaxNumber: | 8889726480 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 NEWTOWN-LANGHORNE RD | ||||||||
| Address2: | ST MARY MEDICAL CENTER OPERATING ROOM | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157102000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2014 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA001381L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.