NPIMap

Organization Active NPI

Fox Chase Cancer Center Medical Group, Inc

  • Psychologist
  • Philadelphia, PA
National Provider Identifier
1366044885
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
FOX CHASE CANCER CENTER MEDICAL GROUP, INC
Practice address
333 Cottman Ave
Philadelphia, PA 19111-2497
Phone
(215) 214-3940
Fax
(215) 214-1425
NPI assigned
Nov 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Squadroni
Title
Credentialing Analyst
Phone
(215) 707-3411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

333 Cottman Ave
Philadelphia, PA 19111-2497

Mailing address

333 Cottman Ave
Philadelphia, PA 19111-2497
Phone (215) 214-3940

Other names 1

  • Psychology Assoc of FCCC, MGI Doing business as

National Provider Directory

National Provider Directory

Locations

333 Cottman Ave
#Int
Philadelphia, PA 19111
Phone (215) 728-2844

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1366044885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112497",
            "telephone_number": "215-214-3940",
            "fax_number": "215-214-1425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112497",
            "telephone_number": "215-214-3940",
            "fax_number": "215-214-1425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOX CHASE CANCER CENTER MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "SQUADRONI",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CREDENTIALING ANALYST",
        "authorized_official_telephone_number": "215-707-3411"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychology Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.