Provider Demographics
NPI:1508817644
Name:ENDOCRINE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:ENDOCRINE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WITTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-657-5200
Mailing Address - Street 1:2300 COMPUTER RD
Mailing Address - Street 2:SUITE H39
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1752
Mailing Address - Country:US
Mailing Address - Phone:215-657-5200
Mailing Address - Fax:215-657-8083
Practice Address - Street 1:2300 COMPUTER RD
Practice Address - Street 2:SUITE H39
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1752
Practice Address - Country:US
Practice Address - Phone:215-657-5200
Practice Address - Fax:215-657-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF15042Medicare UPIN
PAF12151Medicare UPIN
PAI26249Medicare UPIN