Organization
EAST NORRITON PHYSICIANS SERVICES
Active
Other names
Bridgeport Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
PETER B KENNIFF (CFO)
(610) 567-6967
Entity
Organization
Contact information
Practice address
700 DEKALB ST, BRIDGEPORT, PA 19405-1149
(610) 277-6200
(610) 277-3437
Mailing address
1 W ELM ST, SUITE 100, CONSHOHOCKEN, PA 19428-2007
(610) 567-6967
(610) 567-6955
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018011
AUSHC HMO
PA
01
—
0899194001
KHPE
PA
05
—
1007594660059
—
PA
01
—
298
AUSHC OFFICE NUMBER
PA
01
—
5176213
AUSHC PPO
PA
01
—
852929
HIGHMARK BLUE SHIELD
PA
Enumeration date
09/08/2005
Last updated
03/11/2008
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