Healthcare Provider Details

I. General information

NPI: 1679795843
Provider Name (Legal Business Name): NORTHEAST FAMILY MEDICAL AND REHABILITATION CENTER, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 COTTMAN AVE
PHILADELPHIA PA
19111-3606
US

IV. Provider business mailing address

1306 COTTMAN AVE
PHILADELPHIA PA
19111-3606
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-1212
  • Fax: 215-745-4427
Mailing address:
  • Phone: 215-745-1212
  • Fax: 215-745-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BROWN
Title or Position: OWNER
Credential: D.C.
Phone: 215-745-1212