Provider Demographics
NPI:1982669867
Name:WYOMISSING PEDIATRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:WYOMISSING PEDIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-374-4491
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 3170
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-4491
Mailing Address - Fax:610-478-1170
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 3170
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-4491
Practice Address - Fax:610-478-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00865Medicare ID - Type Unspecified