Provider Demographics
NPI:1417712662
Name:BERWYN HEALTH AND WELLNESS PC
Entity Type:Organization
Organization Name:BERWYN HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZYGMUNT
Authorized Official - Middle Name:
Authorized Official - Last Name:PORADA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:443-641-6227
Mailing Address - Street 1:901 LANCASTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1710
Mailing Address - Country:US
Mailing Address - Phone:610-251-2525
Mailing Address - Fax:
Practice Address - Street 1:901 LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1710
Practice Address - Country:US
Practice Address - Phone:610-251-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty