Basic Information
| Provider Information | |||||||||
| NPI: | 1982196036 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARIA HEALTH PHYSICIAN SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | 3B ORTHOPEDICS AT JEFFERSON HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816873 | ||||||||
| FaxNumber: | 2154813985 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 N OXFORD VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152696700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUMOR | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2156124888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1007526250039 | 05 | PA | MEDICAID |