Basic Information
| Provider Information | |||||||||
| NPI: | 1942234836 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST NORRITON PHYSICIANS SERVICES | ||||||||
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| OtherOrganizationName: | EAST NORRITON CARDIOLOGY GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 W ELM ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194282007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105676967 | ||||||||
| FaxNumber: | 6105676170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 DEKALB PIKE | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194011820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106497625 | ||||||||
| FaxNumber: | 6106495178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | KENNIFF | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6102926522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 48436 | 01 | PA | KMHP | OTHER | 0117115000 | 01 | PA | IBC# | OTHER | 8770193 | 01 | PA | AUSHC PPO | OTHER | 544079 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 100759466 0034 | 05 | PA | MEDICAID | 99368 | 01 | PA | AUSHC HMO | OTHER | 0117115000 | 01 | PA | KHPE | OTHER | 009 | 01 | PA | TRICARE | OTHER | 2810 | 01 | PA | HEALTHPARTNERS | OTHER |