Healthcare Provider Details

I. General information

NPI: 1821503038
Provider Name (Legal Business Name): PHILLY NEWLIFE SUBOXONE CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3477 SAINT VINCENT ST
PHILADELPHIA PA
19149-1628
US

IV. Provider business mailing address

3477 SAINT VINCENT ST
PHILADELPHIA PA
19149-1628
US

V. Phone/Fax

Practice location:
  • Phone: 215-966-8666
  • Fax: 215-780-1779
Mailing address:
  • Phone: 215-966-8666
  • Fax: 215-780-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AJAY SINGHAL
Title or Position: PROVIDER
Credential: MD
Phone: 215-966-8666