Basic Information
| Provider Information | |||||||||
| NPI: | 1679117592 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAUDENZIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 W MAIN ST | ||||||||
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| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194014716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102399600 | ||||||||
| FaxNumber: | 6102757025 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173149199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179903500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | CHABAN | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF CORPORATE FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6102399600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | N | Agencies | Public Health or Welfare | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.