Healthcare Provider Details

I. General information

NPI: 1114035326
Provider Name (Legal Business Name): ROOSEVELT FAMILY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 N BROAD ST
PHILADELPHIA PA
19140-1215
US

IV. Provider business mailing address

4517 N BROAD ST
PHILADELPHIA PA
19140-1215
US

V. Phone/Fax

Practice location:
  • Phone: 215-324-1900
  • Fax: 215-324-4239
Mailing address:
  • Phone: 215-324-1900
  • Fax: 215-324-4239

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: DR. MAURICE SINGER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 215-676-3336