Provider Demographics
NPI:1760423230
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:EINSTEIN PHYSICIANS NORRITON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT-ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-622-7391
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:342 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4260
Practice Address - Country:US
Practice Address - Phone:610-279-1500
Practice Address - Fax:610-278-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8146434OtherCIGNA HMO/PPO
PA0047283001OtherIBC - PC/KHPE
PA1026416OtherKEYSTONE MERCY
PA0047283001OtherAMERICHOICE/INTERCOUNTY
PA16523OtherHEALTH PARTNERS SITE #
PA8495020OtherAETNA PPO
PA1738323Medicaid
PA175817OtherHIGHMARK BLUE SHIELD
PA0018105OtherAETNA HMO
PA2123929OtherALLIANCE/OPT CHC (MAMSI)
PADC5012OtherRRM
PA0047283001OtherAMERICHOICE/INTERCOUNTY