Basic Information
| Provider Information | |||||||||
| NPI: | 1710958178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH WILLOW GROVE PEDIATRICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2510 MARYLAND RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156726622 | ||||||||
| FaxNumber: | 2156726566 | ||||||||
| Practice Location | |||||||||
| Address1: | 2510 MARYLAND RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156726622 | ||||||||
| FaxNumber: | 2156726566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 08/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | CIROTTI | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2156726622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.