| Organization Name: | NAZERETH PHYSICIAN SERVICES INC |
| NPI Number: | 1003072166 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID A WAJDA (CFO) |
| Mailing Address: | 2601 Holme Ave Philadelphia |
| State: | PA US |
| Postal Code: | 191522007 |
| Phone Number: | 2153356445 |
| Fax Number: | 2153356303 |
| NPI Enumeration Date: | 07/29/2008 |
| NPI Last Update Date: | 07/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WW0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Wound Care |
| Taxonomy Definition: | |