Provider Demographics
NPI:1962420935
Name:GREEN AND SEIDNER FAMILY PRACTICE ASSOCIATES PC
Entity type:Organization
Organization Name:GREEN AND SEIDNER FAMILY PRACTICE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-855-1054
Mailing Address - Street 1:826 N. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-855-1054
Mailing Address - Fax:215-361-7445
Practice Address - Street 1:826 N. BROAD STREET
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-855-1054
Practice Address - Fax:215-361-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014269E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA401264Medicare ID - Type Unspecified