MEDICARE: THE HEART CENTER OF PHILADELPHIA, P.C.

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1306890421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEART CENTER OF PHILADELPHIA, P.C.

Provider Business Mailing Address
First Line	:	2422 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-389-0600
Fax Number	:	215-389-0604

Provider Business Practice Location Address
First Line	:	2422 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-4418
Country	:	US
Telephone Number	:	215-389-0600
Fax Number	:	215-389-0604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN J NIERENBERG
Credential	:	M.D.
Telephone Number	:	215-389-0607

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/15/2012

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