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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. DAVID WAJDA (CFO)
(215) 335-6614
Entity
Organization
Contact information
Practice address
2601 HOLME AVE, PHILADELPHIA, PA 19152-2007
(215) 350-7417
(215) 335-6303
Mailing address
1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-4108
(610) 567-6967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101465514 0001
—
PA
01
—
2457876000
IBC#
PA
01
—
425807
AETNA OFFICE #
PA
01
—
NA1775677
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/05/2006
Last updated
04/01/2008
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