Provider Demographics
NPI:1114435856
Name:EINSTEIN MEDICAL CENTER MONTGOMERY
Entity Type:Organization
Organization Name:EINSTEIN MEDICAL CENTER MONTGOMERY
Other - Org Name:EINSTEIN ENDOSCOPY CENTER - BLUE BELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-254-3254
Mailing Address - Street 1:5501 OLD YORK ROAD
Mailing Address - Street 2:CORPORATE ACCOUNTING, F & O BUILDING, 2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-254-3255
Mailing Address - Fax:215-456-7377
Practice Address - Street 1:676 DEKALB PIKE STE 100
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1223
Practice Address - Country:US
Practice Address - Phone:610-233-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EINSTEIN MEDICAL CENTER MONTGOMERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-16
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical