Provider Demographics
NPI:1285476432
Name:PENN HEART AND VASCULAR CENTER
Entity type:Organization
Organization Name:PENN HEART AND VASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:215-799-9170
Mailing Address - Street 1:PO BOX 9369
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-9369
Mailing Address - Country:US
Mailing Address - Phone:215-799-9170
Mailing Address - Fax:484-540-7116
Practice Address - Street 1:869 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2105
Practice Address - Country:US
Practice Address - Phone:215-799-9170
Practice Address - Fax:484-540-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty