Provider Demographics
NPI:1609145887
Name:DR. MAGNER AND ASSOCIATES
Entity Type:Organization
Organization Name:DR. MAGNER AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:610-430-9043
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19395-0567
Mailing Address - Country:US
Mailing Address - Phone:610-430-9043
Mailing Address - Fax:610-399-0459
Practice Address - Street 1:20 S 69TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2528
Practice Address - Country:US
Practice Address - Phone:610-430-9043
Practice Address - Fax:610-399-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-18
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002133252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024603250001Medicaid