1134511157 NPI number — ROXBOROUGH MEDICAL OF ANDORRA LLC

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 1134511157 NPI number — ROXBOROUGH MEDICAL OF ANDORRA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROXBOROUGH MEDICAL OF ANDORRA LLC
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:
Provider Other Organization Name Type Code:
6
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:
1134511157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 RIDGE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19128-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-487-4244
Provider Business Mailing Address Fax Number:
215-487-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8500 HENRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-766-6321
Provider Business Practice Location Address Fax Number:
267-766-6322
Provider Enumeration Date:
02/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PAREKH
Authorized Official First Name:
DARSHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-487-4244

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , 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: 1030079750001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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