NPIMap

Organization Active NPI

Nazareth Physician Services Inc

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1659568533
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NAZARETH PHYSICIAN SERVICES INC
Practice address
2614 Woodward St
Philadelphia, PA 19152-1334
Phone
(215) 676-9223
Fax
(215) 676-2235
NPI assigned
Sep 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

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

Authorized official

Name
David Wajda
Title
VP Finance
Phone
(215) 335-6043

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2614 Woodward St
Philadelphia, PA 19152-1334

Mailing address

1 W Elm St
Suite 100
Conshohocken, PA 19428-2007
Phone (610) 567-6967

Other identifiers 1

IdentifierTypeStateIssuer
1014655140002MedicaidPA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1659568533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W ELM ST",
            "address_2": "SUITE 100",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282007",
            "telephone_number": "610-567-6967",
            "fax_number": "610-567-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 WOODWARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191521334",
            "telephone_number": "215-676-9223",
            "fax_number": "215-676-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAZARETH PHYSICIAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "WAJDA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "215-335-6043"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014655140002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 10, 2008; 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.