Provider Demographics
NPI:1801843669
Name:FOUNDATION RESEARCH MEDICAL SERVICES
Entity Type:Organization
Organization Name:FOUNDATION RESEARCH MEDICAL SERVICES
Other - Org Name:UNIVERSITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-637-6800
Mailing Address - Street 1:2837 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1206
Mailing Address - Country:US
Mailing Address - Phone:215-637-6800
Mailing Address - Fax:215-637-7967
Practice Address - Street 1:73 N. MAPLE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-741-7000
Practice Address - Fax:856-741-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNDATION RESEARCH MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099089Medicare ID - Type Unspecified