Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-08-28
- Last updated
- 2026-08-28
Specialties
Licenses
- License PA
- SL019357
Location
- Practice location
- 822 MONTGOMERY AVE
- City
- NARBERTH PA
- Postal code
- 190721937
- Phone
- 215-220-2210
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.