Provider Demographics
NPI:1558550830
Name:VALLEY FORGE FACIAL PLASTIC SURGERY ENT
Entity Type:Organization
Organization Name:VALLEY FORGE FACIAL PLASTIC SURGERY ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-323-1550
Mailing Address - Street 1:206 GAY ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3721
Mailing Address - Country:US
Mailing Address - Phone:610-933-8896
Mailing Address - Fax:610-326-6160
Practice Address - Street 1:206 GAY ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-3721
Practice Address - Country:US
Practice Address - Phone:610-933-8896
Practice Address - Fax:610-326-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVA056046Medicare PIN