Healthcare Provider Details

I. General information

NPI: 1699979161
Provider Name (Legal Business Name): 7622 MEDICAL CENTER DBA 1900 S.G. ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SPRING GARDEN ST
PHILADELPHIA PA
19130-3805
US

IV. Provider business mailing address

2000 SPRING GARDEN ST
PHILADELPHIA PA
19130-3805
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 Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS003726-L
License Number StatePA

VIII. Authorized Official

Name: DR. ARNOLD S. LINCOW
Title or Position: MEDICAL DIRECTOR - PRESIDENT
Credential: D.O.
Phone: 215-564-3618