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NPI Code Detail

MEDICARE: PHILADELPHIA HEALTH MANAGEMENT CORP

MEDICARE: PHILADELPHIA HEALTH MANAGEMENT CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center122660PA

General Provider Information

NPI Number : 1053466086
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHILADELPHIA HEALTH MANAGEMENT CORP
Provider Business Mailing Address
First Line : 260 S BROAD STREET
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102
Country : US
Telephone Number : 215-985-2500
Fax Number : 215-731-2049
Provider Business Practice Location Address
First Line : 111 N 49TH ST
Second Line : 2ND FLOOR
City : PHILADELPHIA
State : PA
Zip : 19139-2718
Country : US
Telephone Number : 215-662-8881
Fax Number : 215-662-8887
Authorized Official
Title or Position : PRESIDENT
Name : MR. RICHARD J COHEN
Credential : PHD
Telephone Number : 215-985-2501
Provider Enumeration Date : 01/23/2007
Last Update Date : 10/01/2010

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1437281318 — CHALA SARGENT MD
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1760502827 — MR. SCOTT WEISENBERGER LPC
Practice Location Address:
111 N 49TH ST
PHILADELPHIA, PA
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1841312196 — DR. KAMBEZE BANAN ETEMAD M.D.
Practice Location Address:
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Directions to “PHILADELPHIA HEALTH MANAGEMENT CORP ” Practice Location

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