Provider Demographics
NPI:1952574915
Name:EDWARD J STRAUSS D.O., P.C.
Entity Type:Organization
Organization Name:EDWARD J STRAUSS D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-728-6500
Mailing Address - Street 1:7604 CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2433
Mailing Address - Country:US
Mailing Address - Phone:215-728-6500
Mailing Address - Fax:610-941-6412
Practice Address - Street 1:7604 CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2433
Practice Address - Country:US
Practice Address - Phone:215-728-6500
Practice Address - Fax:215-728-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004043L207QA0000X, 207QG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008489480001Medicaid
PA0848948Medicaid
PAPA10253OtherQUALMED
PA4220OtherUS HEALTHCARE
PA47153OtherMERCY NON-PAR
PA923629OtherKEYSTONE
PAST994090OtherBLUE SHIELD
PA0008489480001Medicaid
ST406059Medicare PIN
PA47153OtherMERCY NON-PAR
PAST406059Medicare PIN