1053680827 NPI number — PHILADELPHIA HEALTH AND EDUCATION CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053680827 NPI number — PHILADELPHIA HEALTH AND EDUCATION CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILADELPHIA HEALTH AND EDUCATION CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DREXEL UNIVERSITY COLLEGE OF MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053680827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 A ST
Provider Second Line Business Mailing Address:
NELSON PAVILLION, 2ND FLOOR, FAMILY PLANNING
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19134-1043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 A ST
Provider Second Line Business Practice Location Address:
NELSON PAVILLION, 2ND FLOOR, FAMILY PLANNING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-4871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEVINE
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
215-427-6694

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  MD073928L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100757111-0604 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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