Provider Demographics
NPI:1669465209
Name:FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY LP
Entity type:Organization
Organization Name:FOUNDATION SURGERY AFFILIATE OF HUNTINGDON VALLEY LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-914-4602
Mailing Address - Street 1:1800 BYBERRY RD BLDG 10
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3522
Mailing Address - Country:US
Mailing Address - Phone:159-144-6022
Mailing Address - Fax:
Practice Address - Street 1:1800 BYBERRY ROAD
Practice Address - Street 2:BUILDING 10
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-914-4600
Practice Address - Fax:215-947-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17131501261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001397000OtherID # FOR BLUE CROSS
PA1008872050001Medicaid
PA0001397000OtherID # FOR BLUE CROSS