Healthcare Provider Details

I. General information

NPI: 1659552362
Provider Name (Legal Business Name): HJAZI HEALTH CARE P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 HUNTINGDON PIKE STE 1
HUNTINGDON VALLEY PA
19006-8359
US

IV. Provider business mailing address

1124 CREASE ST
PHILADELPHIA PA
19125-4108
US

V. Phone/Fax

Practice location:
  • Phone: 215-324-5052
  • Fax: 215-324-5080
Mailing address:
  • Phone: 215-324-5052
  • Fax: 888-863-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD432731
License Number StatePA

VIII. Authorized Official

Name: DR. IZAT K AL-BACHA HJAZI
Title or Position: OFFICER
Credential: M.D.
Phone: 215-324-5052