Provider Demographics
NPI:1962694067
Name:FIRELY PEDIATRICS
Entity type:Organization
Organization Name:FIRELY PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIRELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-513-7455
Mailing Address - Street 1:364 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2237
Mailing Address - Country:US
Mailing Address - Phone:215-513-1662
Mailing Address - Fax:215-513-3031
Practice Address - Street 1:364 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2237
Practice Address - Country:US
Practice Address - Phone:215-513-1662
Practice Address - Fax:215-513-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM3000X
PA186240013140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA377740Medicaid