Provider Demographics
NPI:1174593123
Name:FOX CHASE MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:FOX CHASE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-742-0712
Mailing Address - Street 1:7500 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2431
Mailing Address - Country:US
Mailing Address - Phone:215-742-0712
Mailing Address - Fax:215-742-5218
Practice Address - Street 1:7500 CENTRAL AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2431
Practice Address - Country:US
Practice Address - Phone:215-742-0712
Practice Address - Fax:215-742-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0201090000OtherBLUE SHIELD & KEYSTONE
PA0012402900005Medicaid
PA0012402900005Medicaid
PA0201090000OtherBLUE SHIELD & KEYSTONE