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Organization
NAZARETH PHYSICIAN SERVICES INC
Active
Organization
NAZARETH PHYSICIAN SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN J KIRBY (EXECUTIVE DIRECTOR)
(215) 335-6614
Entity
Organization
Contact information
Practice address
7044 TORRESDALE AVE, PHILADELPHIA, PA 19135-1915
(215) 332-7772
(215) 332-2547
Mailing address
1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-2007
(610) 567-6967
(610) 567-6170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101465514 0003
—
PA
01
—
2457876002
IBC#
PA
01
—
658619
AETNA OFFICE #
PA
01
—
NA1775677
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/23/2006
Last updated
04/09/2008
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