Provider Demographics
NPI:1316938483
Name:EAST NORRITON PHYSICIANS SERVICES
Entity type:Organization
Organization Name:EAST NORRITON PHYSICIANS SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6967
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:2705 DEKALB PIKE
Practice Address - Street 2:SUITE 309
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-277-6131
Practice Address - Fax:610-277-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007594660063Medicaid
PA7467716OtherAUSHC PPO
PA001750894OtherHIGHMARK BLUE SHIELD
PA3985911OtherAUSHC HMO
PAG001162600OtherAMERICHOICE
PA2418384000OtherKHPE
PA30024838OtherKMHP
PA3985911OtherAUSHC HMO