Provider Demographics
NPI:1174579114
Name:AMBLER PEDIATRICS, PC
Entity type:Organization
Organization Name:AMBLER PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:215-643-7771
Mailing Address - Street 1:602 S BETHLEHEM PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5800
Mailing Address - Country:US
Mailing Address - Phone:215-643-7771
Mailing Address - Fax:215-643-9463
Practice Address - Street 1:602 S BETHLEHEM PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5800
Practice Address - Country:US
Practice Address - Phone:215-643-7771
Practice Address - Fax:215-643-9463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025833Medicaid