Provider Demographics
NPI:1154536274
Name:MANOR COLLEGE
Entity type:Organization
Organization Name:MANOR COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT OF MANOR COLLEGE
Authorized Official - Prefix:
Authorized Official - First Name:SR.
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:JURASINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:215-885-2360
Mailing Address - Street 1:700 FOX CHASE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3319
Mailing Address - Country:US
Mailing Address - Phone:215-887-7617
Mailing Address - Fax:
Practice Address - Street 1:700 FOX CHASE RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3319
Practice Address - Country:US
Practice Address - Phone:215-887-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty