Healthcare Provider Details

I. General information

NPI: 1376734103
Provider Name (Legal Business Name): MERAKEY PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11082 KNIGHTS RD
PHILADELPHIA PA
19154-3511
US

IV. Provider business mailing address

620 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1810
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-3131
  • Fax: 215-273-5975
Mailing address:
  • Phone: 215-836-3131
  • Fax: 215-273-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: MR. NORMAN E TILSON JR.
Title or Position: CORP SR. DIRECTOR OF BUSINESS OPS
Credential:
Phone: 215-836-3131