Healthcare Provider Details

I. General information

NPI: 1104152198
Provider Name (Legal Business Name): 2000 SG ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SPRING GARDEN ST
PHILADELPHIA PA
19130-3994
US

IV. Provider business mailing address

2000 SPRING GARDEN ST
PHILADELPHIA PA
19130-3994
US

V. Phone/Fax

Practice location:
  • Phone: 215-564-3618
  • Fax: 215-564-2239
Mailing address:
  • Phone: 215-564-3618
  • Fax: 215-564-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY LINCOW
Title or Position: CEO
Credential:
Phone: 215-224-8980