Basic Information
| Provider Information | |||||||||
| NPI: | 1851397731 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSEPH F. MAMBU, MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY MEDICINE, GERIATRICS & WELLNESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 714 N BETHLEHEM PIKE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LOWER GWYNEDD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155404411 | ||||||||
| FaxNumber: | 2155404415 | ||||||||
| Practice Location | |||||||||
| Address1: | 714 N BETHLEHEM PIKE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LOWER GWYNEDD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190022655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155404411 | ||||||||
| FaxNumber: | 2155404415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAMBU | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2155404411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | MD017725E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0864515001 | 01 | PA | BCBS-PA KEYSTONE | OTHER | 921651 | 01 | PA | BCBS-PA HIGHMARK | OTHER |