Provider Demographics
NPI:1114206604
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:ENDOCRINE ASSOCIATES OF FORNANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT-ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-622-7391
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:2010 N BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1004
Practice Address - Country:US
Practice Address - Phone:215-997-9441
Practice Address - Fax:215-997-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty