Provider Demographics
NPI:1760794846
Name:MONTGOMERY HOSPITAL
Entity Type:Organization
Organization Name:MONTGOMERY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-277-0964
Mailing Address - Street 1:1250 GREENWOOD AVE
Mailing Address - Street 2:APT 608
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2901
Mailing Address - Country:US
Mailing Address - Phone:267-616-3681
Mailing Address - Fax:
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:MONTGOMERY PROFESSIONAL BUILDING SUITE 409
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:610-277-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty