Provider Demographics
NPI:1154389831
Name:DELAWARE VALLEY INSTITUTE OF FERTILITY & GENETICS, PA
Entity type:Organization
Organization Name:DELAWARE VALLEY INSTITUTE OF FERTILITY & GENETICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TALIADOUROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-988-0072
Mailing Address - Street 1:6000 SAGEMORE DR
Mailing Address - Street 2:SUITE 6102
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3900
Mailing Address - Country:US
Mailing Address - Phone:856-988-0072
Mailing Address - Fax:856-988-7308
Practice Address - Street 1:6000 SAGEMORE DR
Practice Address - Street 2:SUITE 6102
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3900
Practice Address - Country:US
Practice Address - Phone:856-988-0072
Practice Address - Fax:856-988-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0720738000OtherAMERIHEALTH
NJ0552097OtherAETNA INS
NJ0720738000OtherAMERIHEALTH