Provider Demographics
NPI:1790704880
Name:SANATOGA OPHTHALMOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SANATOGA OPHTHALMOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-326-9308
Mailing Address - Street 1:1560 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3225
Mailing Address - Country:US
Mailing Address - Phone:610-326-9308
Mailing Address - Fax:610-326-1301
Practice Address - Street 1:1560 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3225
Practice Address - Country:US
Practice Address - Phone:610-326-9308
Practice Address - Fax:610-326-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010934700002Medicaid
PA428504Medicare ID - Type Unspecified