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Organization
GI ASC LLC
Active
Organization
GI ASC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELYSE CARRULLO (ADMINISTRATOR)
(610) 664-9700
Entity
Organization
Contact information
Practice address
3998 RED LION RD, SUITE 240 - CANCER CENTER, PHILADELPHIA, PA 19114-1436
(215) 632-3500
(215) 632-6533
Mailing address
10 PRESIDENTIAL BLVD, SUITE 124, BALA CYNWYD, PA 19004-1107
(610) 664-9700
(610) 664-6391
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
06181500
PA
Other
Enumeration date
04/10/2006
Last updated
09/06/2012
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