Provider Demographics
NPI:1144250127
Name:BARIATRIC SPECIALISTS OF PENNSYLVANIA, P.C.
Entity type:Organization
Organization Name:BARIATRIC SPECIALISTS OF PENNSYLVANIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT FOREST HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELIHU
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEDESMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-547-1410
Mailing Address - Street 1:135 YPSILANTI
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198
Mailing Address - Country:US
Mailing Address - Phone:734-547-1174
Mailing Address - Fax:734-547-1161
Practice Address - Street 1:280 MIDDLETOWN BLVD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:267-572-3100
Practice Address - Fax:267-572-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
091595Medicare ID - Type Unspecified