Healthcare Provider Details

I. General information

NPI: 1003090291
Provider Name (Legal Business Name): SOLIS PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVE
PHILADELPHIA PA
19128-1737
US

IV. Provider business mailing address

5800 RIDGE AVE
PHILADELPHIA PA
19128-1737
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-4692
  • Fax: 215-487-4274
Mailing address:
  • Phone: 215-487-4692
  • Fax: 215-487-4274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013039
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS005231L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD NEWELL
Title or Position: DIRECTOR, BUSINESS DEVELOPMENT
Credential:
Phone: 215-487-4692