Provider Demographics
NPI:1760429260
Name:EUGENE ANDRUCZYK, D.O., LLC
Entity Type:Organization
Organization Name:EUGENE ANDRUCZYK, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-676-3280
Mailing Address - Street 1:9501 ROOSEVELT BOULEVARD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1029
Mailing Address - Country:US
Mailing Address - Phone:215-676-3280
Mailing Address - Fax:215-567-3821
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-676-3280
Practice Address - Fax:215-567-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB28857Medicare UPIN