Provider Demographics
NPI:1700115847
Name:INTEGRATED DIABETES SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATED DIABETES SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CDE
Authorized Official - Phone:610-642-6055
Mailing Address - Street 1:333 E LANCASTER AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1929
Mailing Address - Country:US
Mailing Address - Phone:610-642-6055
Mailing Address - Fax:610-642-8046
Practice Address - Street 1:333 E LANCASTER AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1929
Practice Address - Country:US
Practice Address - Phone:610-642-6055
Practice Address - Fax:610-642-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service