Provider Demographics
NPI:1639280456
Name:EASTERN PENNSYLVANIA CRNA SERVICES
Entity Type:Organization
Organization Name:EASTERN PENNSYLVANIA CRNA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:856-829-1371
Mailing Address - Street 1:PO BOX 2737
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-5737
Mailing Address - Country:US
Mailing Address - Phone:856-829-1371
Mailing Address - Fax:856-829-3438
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3062
Practice Address - Country:US
Practice Address - Phone:215-742-6972
Practice Address - Fax:215-742-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN159329L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3272535OtherAETNA
PA0298587000OtherINDEPENDANCE BLUE CROSS
PA104935Medicare ID - Type Unspecified