Provider Demographics
NPI:1952661134
Name:KIMMEL NASAL AND SINUS CENTER
Entity Type:Organization
Organization Name:KIMMEL NASAL AND SINUS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-366-4606
Mailing Address - Street 1:2211 QUARRY DR
Mailing Address - Street 2:SUITE E58C
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1161
Mailing Address - Country:US
Mailing Address - Phone:610-927-5394
Mailing Address - Fax:610-927-5796
Practice Address - Street 1:2211 QUARRY DR
Practice Address - Street 2:SUITE E58C
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1161
Practice Address - Country:US
Practice Address - Phone:610-927-5394
Practice Address - Fax:610-927-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty