Provider Demographics
NPI:1699967315
Name:TERRY M KANEFSKY MD
Entity type:Organization
Organization Name:TERRY M KANEFSKY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-752-3035
Mailing Address - Street 1:1205 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:215-752-3035
Mailing Address - Fax:215-752-2017
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-752-3035
Practice Address - Fax:215-752-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2008-01-10
Deactivation Date:2007-11-05
Deactivation Code:
Reactivation Date:2008-01-10
Provider Licenses
StateLicense IDTaxonomies
PAMD015888E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty