Provider Demographics
NPI:1811003353
Name:FERTILITY & GYNECOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FERTILITY & GYNECOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONORE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HUPPERT
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-3921
Mailing Address - Street 1:800 SPRUCE ST
Mailing Address - Street 2:ONE PINE BUILDING EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-6385
Mailing Address - Fax:215-829-6553
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:ONE PINE BUILDING EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-6385
Practice Address - Fax:215-829-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA755403Medicare PIN