Provider Demographics
NPI:1730622994
Name:ELWYN HEALTH SERVICES OF PENNSYLVANIA PC
Entity type:Organization
Organization Name:ELWYN HEALTH SERVICES OF PENNSYLVANIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:610-891-2021
Mailing Address - Street 1:111 ELWYN RD
Mailing Address - Street 2:
Mailing Address - City:ELWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4622
Mailing Address - Country:US
Mailing Address - Phone:610-891-2000
Mailing Address - Fax:
Practice Address - Street 1:111 ELWYN RD
Practice Address - Street 2:
Practice Address - City:ELWYN
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELWYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid Equipment