Basic Information
| Provider Information | |||||||||
| NPI: | 1497312656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAZARETH PHYSICIAN SERVICES, INC | ||||||||
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| OtherOrganizationName: | NAZARETH HEALTH RESIDENCY CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105472527 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2601 HOLME AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153356000 | ||||||||
| FaxNumber: | 2153356303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2019 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARUSO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2157102651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.