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1220 Broadcasting Rd Ste 100 Wyomissing PA 19610-3221 | |
| (484) 628-5673 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Surgery |
| Location | 1220 Broadcasting Rd Ste 100, Wyomissing, Pennsylvania |
| Authorized Official Name and Position | Robert Ehinger (SR VP FINANCIAL OPERATIONS) |
| Authorized Official Contact | 4846281324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 13579 Reading PA 19612-3579 Ph: () - | 1220 Broadcasting Rd Ste 100 Wyomissing PA 19610-3221 Ph: (484) 628-5673 |
| NPI Number | 1194892471 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 11/26/2021 |
| Certification Date | 11/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194892471 | NPI | - | NPPES |
| 072790 | Other | PA | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (* (Not Available)) | Primary |
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