Provider Demographics
NPI:1982216107
Name:DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIVORNESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-896-0210
Mailing Address - Street 1:901 MCCLINTOCK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:630-655-7290
Mailing Address - Fax:630-655-7290
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST 556
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELAWARE VALLEY I.D. ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy