Provider Demographics
NPI:1942232244
Name:DANZIS, JEFFREY J (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:DANZIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E BUTLER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5257
Mailing Address - Country:US
Mailing Address - Phone:215-822-3113
Mailing Address - Fax:215-822-0889
Practice Address - Street 1:65 E BUTLER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5257
Practice Address - Country:US
Practice Address - Phone:215-822-3113
Practice Address - Fax:215-822-0889
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002688L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006145640001Medicaid
PA082376E2GMedicare ID - Type Unspecified
PAB35234Medicare UPIN